HomeMy WebLinkAboutWiring Permit - Permits #11465 - 209 JOHNSON STREET 3/18/2013 Date.................. _.............
�NoprH�ti TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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BOARD OF FIRE PREVENTION REGULATIONS ! Rev.
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: To the Inspector of Wires:
By this application the undersigned gives notice of h or her intention to perform the electrical work described below.
Location(Street&Number) -
Owner or Tenant �� t, ` Telephone No.
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/eW Amps 449 /e ` olts Overheadw 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: &ak/
Completion ofthefollowing table trraybe 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 K-VA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
rnd. rnd. 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
Total Initiating Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
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 ElMunicipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or E uivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: al
No.of Devices or Equivalent
Attach additional detail if desired,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 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: INSURANC BOND ❑ OTHER ❑ (Specify:)
I certify, under the p i s attd penalties of perjury that the information on th' a plication is true and complete.
FIRM NAMIB ..
LIC.NO �r� ,. 91 ,4
Licensee: , 00�/Y 01 f&FIV Signature LIC.NO.: 'S 01-0.�
(IfapplicabJ�,enter "exert"in the li erase nrrrlrber;lin�� Bus.Tel.No.;�(Jl
Address• t' Glf /� Alt.Tel.No.:
*Per M.G.L. c. 147,s. 57-61,security work requires Depa ent of Public afety"S"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
Signature Telephone No. PERMIT FEE: $
;�EG15TER�C1 IVIASTER ELECTRICIAN
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JOSEPH P OBRIEN
&9 SHERWOOD RD
M�HDFORD MA 02155-1662 a�
20-729 'A 07/31/13 834089gplum
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10MO W AL.'I l OF 10AS115ACIU)SE
ASq�REG Jf�I1RNEYM °°
AN ELECTRICIAN
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JOSEPH P O'BRIEN
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39 SHERWOOD ROAD }
MEDFORD MA 02155-166
50824 E 07/31/13 834088
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