HomeMy WebLinkAbout- Permits #11818 - 1 HIGH STREET 8/28/2013 I
1
Date G.: ' �'��:.. .........
I
o�NowTHq� TOWN OF NORTH ANDOVER
a PERMIT FOR WIRING
n'd�
9
This certifies that ..............
has permission to perform
H
wiring in the building of ..............
J' orthAndover,Mass.
at .. 3
257 Fee.. "� .. .. Lic.No ."' ..••• E� CALIxsrEcrox d'
Check# 9)_ _�_ -` ) 0
Official Use Only Commonwealth of Massachusetts
Department of Fire Services Permit No. la
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/071 (leave blank
,APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. WORK
All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL,INFORMATION) Date: 9 f ZFh 3
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) Qh)4 -4i&7ff .5 -1-
Owner or Tenant t ymV e A-,S2 Telephone No.
Owner's Address a k1et-b\k&m: G i
Is this permit in conjunction with a building permit? Yes ❑ No ®, (Check Appropriate Box)
Purpose of Building 04,c C.�-- 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
Location and Nature of Proposed Electrical Work: &C U('e 1 o R i r 116 r
S 1 � S �412d
Completa n of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No. of Total
Transformers KVA
No.of Luminaire Outlets No, of Hot Tubs Generators KVA
No. of Luminaires Swimming Pool Above In- ❑ o,-OTEmergency Lighting
rnd, grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones S
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
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained -
Totals; """""""' """"""'"""""'... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW curity System . "-- 5-6
No.of Water No.of No.of No.o r Equivalent
Heaters KW Ballasts Data Wiring:
Signs No.of Devices or Equivalent_
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: �Q (When required by municipal policy.)
Work to Start: -'Z$ 1 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
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE F1 BOND ❑ OTHER ❑ (Specify:)
I certify,under ihepains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: . -1"t'Z() A�':j/�[; 5 L-9962ftbLAffi . I V LIC.NO.:
Licensee: l�� - - LTC.NO.:
3.gae � Signature �ti,
(If applicable,enter "exempt in the lie nse nz� bar li e.) ' Bus,Tel.No.• U `cl y 3 (( A 22
Address: .l." a � V GL Cr (/lS �Z0z� Alt.Tel.No.: y66-245p 1b1.7
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety" "License: Lie.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. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.