HomeMy WebLinkAboutWiring Permit - Correspondence - 79 GRAY STREET 9/1/2015 z�
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i Date........a'/.............: . ...........
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NONTH,�O`
O TOWN OF NORTH ANDOVER
a PERMIT" FOR WIRING
3ACHU5E
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This certifies that ..................s G.p `....................r.:=...:...... . .... .: :....................................,.......
has permission to perform
.... ....... ...
wiring in the building of......,`.......: -
.................. ........................................................................
at ., g North Andover,Mass....:................ L ... '......................
Fee .J........... .........Lic.No._ ........P �s. z:::...... ....`..s.'.4 i�........................
6 ELECTRICAL NSPECTOR
j Check# 6
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Commonwealth ®f Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code JQ
P �27 CMR 12.00
(PLEASE-PRINT Date:
City or Town of: NORTH ANDOVEi R To the Ins e&d of Wires:
By this application the-undersigned gives notice of his or her intention to 0 prm the electrical work described below.
Location(Street&Number)_ "T"I e-7-116',14",
Owner or Tenant J Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes U"' No D (Check Appropriate Box)
Purpose of Buildings, IJ4 —Utility Authorization No.
Existing Service Amps Volts OverbeadF] UudgrdF] No.of Meters
New Service Amps volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
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Completion of the following 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 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above Ej In- N-o.-o-f Emergency L><g ting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones
of Detection and
No.of Switches No.of Gas Burners No. Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat PTo um p IATA�K].TqA§..........IW........... No. of Self-Contained
No. of Waste Disposers tals: ........... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating K W Local Municipal E] Other
Connection
-
urity Systems:*
No.of Dryers Heating Appliances 111-W Sec No.of 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 HP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of El trical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NIEC Rule 10,and upon completion.
INSURANCE
COGE: Unless waived by the owner,no permit for the performance of electrical work may issue'unless
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the licensee provides proof of liability i*urance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cpovq�gc is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND El OTHER F1 (Specify:)
I cerqy, un der the pqa,yig an dp en allies ofp eijury,th at th e lyforn i ation on this application is true and complete —2
FIRM NAME: LTC.NO
.41(�rl
A Signature
Licensee: LIC.NO.:
(If applicabie,enter "�ex'e'n I"in t�e leense it berline.) Bus.Tel.
(5 YJ JQ �,4 1 Alt.Tel No.:
Address: 4 1
*Per M.G.L c. 147,s.57-61,security work requiris DepartmentSafety"'S"License: Lic.No.
OWNER'S INSURANCE WAIVE R: 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. I am the(check one)n owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $