HomeMy WebLinkAboutWiring Permit - Permits #13318 - 10 FIELDSTONE COURT 5/19/2015 Date....... .....................
tjORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that
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has permission to perform .......... ..... "--" v,
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wiring in the building of...........................I........
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at 10 ...... ..........................................-;�,North Andover,Mass.
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ELEcTRICALINSPFCTOR
Check#
Commonwealth of Massachusetts Official Use Only
Department of Fire Services' Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblLnK)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3`12--1 S..
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention toperform the electrical work described below,
Location(Street&Number) I V f::, ( J Sf <')-
0 Al 0-. C
Owner or Tenant I C>T)a.% 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 n Undgrd 0 No.of Meters
New Service Amps Volts Overhead FI UndgrdF] No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Cam pletionofthefiollowingtableinayhe waived by the Ins pectot,qfWires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers ICVA
No.of Luminaire Outlets No.of Hot Tubs Generators ICVA
No.of Luminaires Swimming Pool Above Ei In —N-07-OTEmergency Lighting
tyrnd. grnd El Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatin
No.of Ranges No.of Air Cond. Total Devices
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/Are'a Heating IM Local El Mu"c'PP' [j Other
Connection
No.of Dryers Heating Appliances Im Security Systems: —
No.of Water KW No.of No.of No.of Devices or Equivalent
Data Wiring:
Heaters Signs Ballasts No.of Devices or Eguivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications
No.of Devices or E uivalent
OTHER:
Attach additional detail ifdeslred,or as required by the Inspector of Wires.
Estimated Value of Elqctrical Work (When required by municipal policy.)
Work to Start: If / Inspections to be requested in accordance with MEC Rule 10,and upon completion,
INSURANCE COVE,RAGE: 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 cover is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE � BOND n OTHER [I (Specify:)
I certify,under the pains andpenalfles ofpeijuty,that the lqformatlon on th' a P"lleation is true and con;jletie.
FIRM NAME: fV G P,�Lµ I'TYL 7, LIC.NO.:
Licensee: Signature LI C.NO.: V vs:) E
(Ifapp7icable,enter exec in th license number line.)
r Address: 401 us.Tel.No..-,.9*- 6V-�09F
Alt.Tel.No.)Q)JE --Si 5"'-1
*Per M.G.L c. 147,s.57-61,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)El owner 0 owner's Mont.
Owner/Agent
Signature Telephone No. PERMIT FEE.
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