HomeMy WebLinkAboutWiring Permit - Permits #12944-1 - 80 FLAGSHIP DRIVE 12/10/2015 Date......z�.
I NORTH
TOWN OF NORTH ANDOVER
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* a PERMIT FOR WIRING
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This certifies that t � ^
has permission to perform ....�°';
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wiring in the building of ,� t �� t
at ...... t)........... 4P.. i .. . �� f �� �. No h)Andover,Mass.
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Fee/.i.S� ��
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.................Lic. No. .��. �a... .. �� ... .......................
ELECTRICAL INSPECTO...
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1fom•monweaR o f WaddacAudeib Official Use Only
2cc-�� cc-� Permit No.
epartmenl o151re Service!
Occupancy and Fee Checked
y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: A/,,o
City or Town of: Aki �4 NO oLy L-�4 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)
Owner•or Tenant 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 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: y� <>� .S',%72,
Completion o the following table may be waived by the Inspector of Wires.
of
No.of Recessed Luminaires No.of Ceil: P•(Paddle) Trans Sus addle Fans s Total
Trsformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ o
In- ❑ .o tne Lighting
_ _ _ Prnd. rnd. Batteg Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
of
No.of-Switches No,of Gas Burners No. InDetection and
Initiatin Devices
No.of Ran es No.,of Air Cond. Total No,of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number_Tons KW No. of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local Municipal ❑ Other
P g ❑ Connection
No.of D ers Heating Appliances Kam, Security Systems:*
tY No.of Devices or E uivalent
No..of Water No.of No. of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications firing:
No. H
Y g No.of Devices or E uivalent
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 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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties nfneriurv. that the information.on this application is true and complete.
FIRM NAME: LTC.
Licensee:,CIA-n' .�,�F ELECTRICAL SERVICES j` y LTC.NO.:
(Ifopplicable, enter "exempt"in the licen: Bus.Tel. No . �.'-9/�• 3` —of
Address: P.O. Box 8062 Alt.Tel.No.:
*Per M.G.L. c. 147,s. 57-61,security Ward Hill, MA 01835 )f 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 [1 owner's agent.
Owner/Agent PERMIT FEE: $ l Z$---->
Signature Telephone No.