HomeMy WebLinkAboutWiring permit - Building Permit - 15 BRADSTREET ROAD 2/26/2014 R
Date... `...
TOWN OF NORTH ANDOVER
{ * * PERMIT FOR WIRING
ICHUBE�
This certifies that :
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has permission to perform Uk C,r (I�,
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wiring in the building of......� C k AJ%yf ��
........................................................... ....... North dover,Mass.
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EL CTRICZ INSPECTOR
' Check# ''�'' T
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C.ommonweahk of V7 amaclwdelfi i Official Use Only
eUePartment ol tire.�erulcee Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code WE ),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE A L T,_,�r=T'ON)F Date: L � /
City or Town of: /(f�1" To the Inspector of Wires:
By this application the undersigned gives notice of his or�h�er,intention to perform the electrical work described below.
Location(Street&Numbeo 5d
Owner or Tenant /9-t%)c-L Telephone No. Iseg
Owner's Address S�Y�
Is this permit in conjunction with a building permit? Yes No' ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number.of Feeders,and.Ampacity- � ql)/4,AL
Location and Nature of Proposed Electrical Work: )l,/60 i_1'/0c` d
,,,
Completion ofthefollowing table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No of Luminaire Outlets /��i No.ofHot Tubs Generators. KVA
No.of Luminaires / Swimming Pool rnd.Above ❑ nr nd. Batt❑ o. a nits me rg rng
nits
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.o etection and
Initiating Devices
No.of Ranges No.of Air Cond-. Tons No.of Alerting Devices
No.of Waste Disposers Heat ump umber Tons KW No.o Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers _�- Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW ecurity Systems:*
No.of Devices or Equivalent
�-
No.. Water KW No. No.a Data Wiring:
Heaters Signs Ballasts No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors Total HP Te ecommunications firing:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: /j (When required by municipal policy.) /l
Work to Start:��/y Inspections to be requested in accordance with MEC Rule 10,and upon completion. ._
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The 17—
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties Of Perjury,th t lte informatton on dais application is true and completes
FIRM NAME: � �k, oi^r!S GL-C= LIC.NO.: I�D
Licensee: /e%/G �?:// � �� Signature G LIC.NO.:u `jOj
of applicable,enter "exempt"i theyI¢erase number line. n Bus.Tel.No.:
Address: Gt��lJr�/; � Alt.Tel.No..
*Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. lam the(check one)❑owner ❑ owner'sagent.
Owner/Agent PERMIT FEE: $ ❑
Signature Telephone No.
i
Ccsion althofROasa Usetts
Division of Registrali N
i Board of Electri
MICHAE� '=
S
9 WAVE _
NORTH A
Master Elec J a
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21705-A 07/31/2016
License No. 008772
Expiration Date. Serial No.