HomeMy WebLinkAboutWiring Permit - Permits #13064-1 - 20 JOHNSON STREET 1/28/2016 I' Date............. ...
Of NoarM,H TOWN OF NORTH ANDOVER
9 PERMIT FOR WIRING
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Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
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(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: j a J 9.. it"
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) -D.O 5c,1rvrs,. ,Act A
Owner or Tenant L e C'r A Telephone No.
Owner's Address r R4 �JC4 6 W, tivso-.Je- MN, 0t9,3t,;
Is this permit in conjunction with a building permit? Yes R No ❑ (Check Appropriate Box)
Purpose of Building (A F6 ;k,,( Utility Authorization No.
Existing Service Joc, Amps kzL, / -,�%-V) Volts Overhead ❑ Undgrd FA No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (',kcu!,e 0,ne( {( ) 4L 1 UCH A
Completion of the followingtable maybe waived b y the Inspectorof 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
Above In- o. Emergency Lighting
No.of Luminaires +�� Swimming Pool rnd. ❑ grad. ElBatteory Units
r No.of Receptacle Outlets U No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatin Devices
No.of Ranges No.of Air Cond. Total 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❑ Municipal Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters I Signs Ballasts I No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of I'Vires.
Estimated Value of Electrical Work: ,5ou (When required by municipal policy.)
Work to Start: i� _�(� 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 cove• e is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pairs and penalties of perjury,that the information on this application is trite and complete. (�
FIRM NAME: LIC.NO.: LI J 171
Licensee: (ljt G �� s�� t Signature LIC.NO.:
(Ifapplicable,enter "exempt"in the licdnse number line.) J Bus.Tel.No.:
Address: 2k —N\�z MK w,35 Alt.Tel.No.: tll�-316 IL1
*Per M.G.L c. 147,s7,s.57261,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
Signature Telephone No. PERMIT FEE. $
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