HomeMy WebLinkAboutwiring permit - Building Permit - 66 BRADSTREET ROAD 1/7/2016 54 Commonwealth ®f Massachusetts Official Use Only
Permit No.
Depart nt me of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code WC),527 CMR 12-00
(PLEASE PRINT IN JAW OR TYPE ALL INFORMATION) Date: ) _ 7 _ / L
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant :5-1, Had t Telephone No.
Owner's Address 13 6 ,4 vs 1-9 6 rl-
Is this permit in conjunction with a building permit? Yes [❑I No F] (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps volts Overhead [] UndgrdE] No.of Meters
New Service Amps volts OverheadF] TJndgrdF] No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.o Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators E—VA
No.of Luminaires Swimming Pool Above Ei In- El TTO_,-omergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo, of Zones
No. of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No. of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat pump Number y ITons KW No.of Self-Contained
No. of Waste Disposers -Totals: :, ['""" [ ** * * Detection/Alerting Devices
No. of Dishwashers Space/Area Heating I(W Local[:] Municipal Other
Connection
urity ystems:*
No. of Dryers Heating Appliances KW SecNo.of S Devices or Equivalent
No. of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts . No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total IIP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: Z,&42 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NIEC 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
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE F1 BOND El OTHER n (Specify:)
I cerlIfy, i i n de r th e p a in 7sn I p en a Ifies oAp er.wyt hat file I rination on this application is true anti complete.com 0 IV�
FIRM NAME: LIC.NO.:
A
Licensee: /_ -
& Signature -- LIC.NO.:
(If applicable,enter "exetnpt"in the license number 1In,.Tel.No.
Address: 9 ��-OSee "Dl— �t/,,,�t IVY 0,35, 6 7 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 WAN IAR: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. ignature lreby waive,this requirement. I am the(check one)[I owner El owner's agent.
Owner/Agent
Signature Telephone No. PPPMIT FEE: $ L/S
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