HomeMy WebLinkAboutWiring Permit - Permits #12943 - 30 IRONWOOD ROAD 11/26/2014 Date....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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wiring in the building of...................
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...........................Lic.No.
ELECTRICAL INSPECTOR i
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Clnunonweafilt of Wamac4u.4 e th Official Use Only
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2epaph"d ol�7 Permit No.ipa Service.4
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME, ),527 CMR 12.00
(PLEASE PRINT jNiNKoRn,PE ALL INFORMATION) Date.- � 72 ) I ) tj
City or Town of: Zt,e L J,,Ie le tl(l To the lnspeetar of Vtires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 4,')L!,�Lel
Owner or Tenant I< 4 Telephone No.
Owner's Address o J'� L
0
4� ZZ,
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building_ Utility Authorization No.
Existing Service Amps Volts Overhead El Undgrd M 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 thefiollouling table may be waived by the Inspector of Wires.
No.of
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Trans Total
formers KVA
No.of Luininaire Outlets No.of Hot Tubs Generators KVA
Above F-i In ❑ No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. grud. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Detection and
No.of Switches (<,0'lf as Burners--) 2 , Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump No of Self-Contained
Totals: Detection/Alerting Devices
F1 MunicipalNo.of Dishwashers Space/Area Heating KW Local connection El Other
y Systems:*
No.of Dryers Heating Appliances 11(W Securit No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalen
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalen
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work toStart: 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.
CHECKONE: INSURANCE FA` BOND n OTHER n (Specify: IWeomj)lefe.
I certify,under thepains andpenalties ofperjury,that the inforination o)11/hjl"/ fi d n is true ah
FIRM NAME: tj I'tt"e'<, 1v ei (7(1pp 1ca 10 LIC.NO.: [-36!1(; ,7
Licensee: Signature ba a/ LIC.NO.:
(1fapplicable, enter "exempt"in t e license nignber line. !�7 b 61 Bus.T
1'ye� o/c IA/ ;z � 4 /z
Address: Alt.Tel.No.:
*Per M.G.L. c. 1471,S.57-61,security work requires Department of Public Safety"S"License: Lic.No. Ile
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 El owner El owner's agent.
Owner/Agent
Signature Telephone No. FE)WIT FEE: $