HomeMy WebLinkAbout- Permits #12752 - 243 HICKORY HILL ROAD 9/18/2014 5-1
i Date
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TOWN OF NORTH ANDOVER
* * PERMIT FOR WIRING
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This certifies that „
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Permission to perform � �
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wiring in the building of,,,,,•
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v ...fr ,North Andover,Mass,
Fee Lic
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EEECTRICAL INSPECTOR . >
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Commonwealth of Massachusetts Official Use Only
Department f Fire Services Permit No. Z- ?5 Z—
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblattk
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
.All work to be performed in accordance with the Massachusetts Electrical Code C), 7 CMR 12.00
(PLEASE PRINT IN.INK OR TYPE ALL INFORMA TION) Date: —
City or Town of: NORTH ANDOVER To the.Inspector of Wi es:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 3 H(C.-V-CLv o "
Owner or Tenant . f .d C� t. Telephone No.
Owner's Address t/v
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building LA-,1 c,n 1 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:
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 ❑ In- ❑ o.o mergency Lighting
rnd. rnd. Battery Units
No.of Receptacle Outlets ( No.of Oil Burners FIRE ALARMS No, 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
g Tons
No.of Waste Disposers Heat Pump Number Tons KW Pete
o.of Self-Contained
p Totals: ' ' "..""...... ction/Alertin Devices
No.of Dishwashers S ace/Area Heatin KW ocal❑ Municipal Other
p g Connection
No.of Dryers Heating Appliances KW SecN.o Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Tel No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value AE1 ect ical Work: (When required by municipal policy.)
Work to Start: InspeAions to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C VE GA 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 cover5geis in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, antler the pains and penalties ofpeijuiy,that the information on this application is true and complete.
FIRM NAME: • �1, LIC.NO.:L1
Licensee:/\-'U(,CC AAA-f_(�j,� t Signature LTC.NO.:
(If applicable nter "exempt"in the license number line.) Bus.Te.No.:
Address: --4-1
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. I am the(check one)❑ owner ❑owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.