HomeMy WebLinkAboutWiring Permit - Permits #11526 - 163 FARNUM STREET 4/17/2013 Date ..���. ... ..` .
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
E CHUS�
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This certifies that ....................... .. L .. :..1z Zee..(w2...................................
j has permission to perform �� ......................
wiring in the building of....... .. .� ... ..........................
at .....�. .a.....�® �, .:: r North Andover,
), ,Mass.
Fee ..... Lic.No. ..(... .......................
ELECTRICAL INSPECTOR;
Check# Yd z
Commonwealth of Massachusetts 0,1161111 Use Only
Department of Fire Services Permit No. /1 7,
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS R ev l/0 71 (leave_bl,nik)"
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CNM 12.00
(PI EAST"PRINTIN INK OR TYPE ALL IWOR M4 770N) Date:
City or"Town of. NOR'fl-t ANDOVER lb the Inspector offires:
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 2�C J- Telephone No!?;7-k,3QA 4A,—
Owner's Address
Is this Permit in conjunction with a building permit,? Yes JX No (Check Appropriate Box)
Purpose of Building 1 Utility Authorization No.
ILI—�—11"LL-1 �ILLZ-1 - -- —
Existing Service Amps Volts Overhead [I UndgrdE] No.of Meters
New Service Amps Volts Overhead undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 7
----------------7 ------------
CO1 Of de olloirin table ia be)vaed bi �toi2[.HWT No.of Recessed Luminaires No.of Coil.-Susp.(Paddle)Fans No. of Total
-ansformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above El In- [Ell 0.0lug
'Erfi—er—g—eii—CS-1
grud. grud. Batten Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No. of Gas Burners No.of Detection and
Initiatiqg Devices
No.of Ranges No.of Air Cond. Total No.of Alertim,Devices
Tons
No.of Waste Disposers Heat Pnunp Nnmber]Tons [NW No.of Self-Contained
-.-- I Detection/Alerting-Devices
No.of Dishwashers Space/Area floating KW J,ocal[:] Municipal El 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 'Signs, Ballasts No.of Devices or E n►ivaleut .
Telecommunications Wiring:
No.Hydroniassage Bathtubs No.of Motors Total HP No.of Devices oi-Equivalent
OTHER: ('1)4! - /'�""',,>
"Attach additional detail if desired,Or cis required 41,the bispector of Mves.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start, Inspections to be requested in accordance with NMC Rule 10,and upon completion.
INSURANCE COVE"GE: 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 [-] OTIIE'R n (Specify:)
I certif y,under the pains and penalties ofpeiYurr,that the information on this application is trite and complete.
FIRM NAME: LIC.NO.:
Licensee: Signature LIC.NO.:(If applicable,enter ffenipt"in the license nuitibei-,line.) Bus.Tel.No.:
Address: Alt.Tel.No..
*Per M.G.L e. 147,s, 57-61 security work requires Dep/artnient of Public Safety"S"License: Lic.No.
OWNER'S INSURANRJ RIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by a1A,. By tul'ture below,I hereby waive this requirement. I am the(check one)El owner El owner's agent.
Owner/Agent ?7v,
Signature lt!�� —Telephone No. I PERMIT FEE: $
�t �=/O--! 3 ��
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License Type: JOURNEYMAN ELECTRICIAN
yP TYPE CLASS: E Glossary of license Status
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License Number: 15411
Status: CURRENT ulcre';
Expiration Date: 7/31/2013
Issue Date:
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