HomeMy WebLinkAbout- Permits #10260 - 51 HAY MEADOW ROAD 9/20/2011 0*,
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
A us
CHUS
This certifies that ..................... ..................................
has permission to perform ............ .... .....................
wiring in the building of.......... ......................I............................
at..... North Andover,Mass.
Fee... Lic.No. ........
ELECTRICAL INSPECTOR
Check #
__ ( onryrwreu eatt�a o�//Ja��aciuceel Official Use Only
t� (� Permit No.
aG Jeparinu in ol..Jiro ,Jervice6 � —
t BOARD OF FIRE PREVENTION REGULATIONS occupancy and Fee Checked
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL '4J1lORK
All work to be performed in accordance with the Massachusetts Electrical Codc OE ),527 CMR:12,00
(PLF,ASE PRINT IN INK OR T'YP ALL,TWO IATION) Date; �x i
City or Town of: wgi,�s not of 1 ( ; To the Inspector of Wires:
yV,.�
By this application the unders'tgneins or her intention to perform time electrical work described below.
Location(Street& N tuber) h
Owner or Tenant
,f -- Telephone No.
K
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps 1 Volts Overhead ❑ Und rd
g ❑ No, of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: b ;` tC � '
nn
V C% �w V f�I)V�/�. V � 0 � Q A r Cam.
Com ledon 9f the. ollorvin table ninybe waived b the Ins ector o 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
Above In-. o.o mergency Lighting
.
No.of'Ltinminaires Swimming Pool grlld. errldl. d Batte ,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.
Total
No,of Ranges No.of.Air.Conti: Tons No.of Alerting Devices
No.of Waste Disposers Cleat Pump Number Tons I4 4i'_ No:of elf-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area heating KW Local Municipal ❑ (3tlier
Connection
Security S stems:*
No.of Dryers Heating Appliances KW y
No,of D of or Equivalent
No.of Water KW No.of. No:of Data Wiring;
Heaters Ballasts
Signs No.of Devices or Equivalent
No. Hydromassage Batltttibs No,of Motors Total FIP Telecommunications Wiring:
No.of Devices or Equivalent
OTIJE R:
Attach additional detail ifdesireo�or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy,)
Work to Start: _ Inspections to be requested in accordance with ivIEC 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 ❑ BOND ❑ OTHER ❑ (Specify:)
FIRM NAM ---at p o��f i f pP rue and .NO.:
1 certlf under tl ns and ena ties perjury,that the in onnation on this a lication is t
Licensee: "L� ( Signature �., �. � ` i LAC. NO.: w, G ( 0
(1 PA ,... p t �� �' ..� 10
L, �i t ,. Alt,Tel.No.Bus.Tel. .
*Per M.G.L.c. 147 ress: rs.57l'61�security Work DC a ment o Public Safety" S"License: Lic,No. C`)
� ],,security q P y«
OWNER'S INSURANCE WAIVER: 1 am aware that time Licensee does not have the liability insurance coverage normally
required by law. By my signature below,1 hereby waive this requirement. I am the(check one).[]owner ❑owner's agent,
Owner/Agent
Si-nature Telephone No. PFKR277'£7E: S