HomeMy WebLinkAboutWiring Permit - Permits #11955 - 39 DAVIS STREET 10/24/2013 Date. 1.......
.. �... ...
L..
�p10R7/�
TOWN OF NORTH ANDOVER
# PERMIT FOR WIRING
9,�8ACHU8��1
This certifies that( 3 g
�: t:, r � ;,�,
f
has permission to perform &
wiring in the building of ........... :..�.. ....i.�
�° '
at ,, ` .......� ei ��
•... ,NoA Andover,Mass.
Fee... .......Lic.No. �
l.......... ELECM!ALINSPE
Check#
f
+ � m
i
Commonwealth of Massachusetts Official Use 0 1
Permit NO.
Department of Fire Services
Occupancy and Fee Chocked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank)
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: 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) e7>-v E)Ea�
Owner or Tenant UJM EjR Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes V No F1 (Check Appropriate Box)
Purpose of Building A L— Utilit YAuthorization No.
Existing Service i c) 0 Amps I,J24 0 Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps Volts Overhead n Undgrd [I No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
(1, Ac j,,A V7.
Completion of the followingtable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminalre Outlets No. of Hot Tubs Generators KVA
No. of Luminaires Swimming Pool Above n In- No-.—OTEmergency Lighting
grnd. grnd. F] Battery Units
No.of Receptacle Outlets No.of Oil Burners I=ALARMS No. of Zones
No.of Switches No. of Gas Burners No. of Detection and
Initiating Devices
No. of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number I Tons I KW No.of Self-Contained
Totals: I I * * I ............ Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local El Municipal F] other
Connection
Security Systems:*
No.of Dryers Heating Appliances KW No.of Devices or Equivalent
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:
No.of Devices or Equivafent
OTHER:
Attach additional detail if desired,or as required by the Inspector of 9*,es.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with WC 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 n BOND 171 OTHER R (Specify:)
I certIfy, under the pains and penalties ofpeijuq,that the inform tion on this application is true and compl
ete,
FIRM NAME: LTC.NO.:
TI, Signature LIC.NO.:Licensee:
(If applicable,enter "exempt"in the license number line.)
Bus.Tel.No.:-.
Address: IJ D Alt.Tel.No.: OF�--7?G 1c;
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safe tq"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ingrate coverage normally
required by law. By my signature below,I hereby waive this requirement, I am the(check one) t,❑owner F] owner's agent.
Owner/Agent
Signature TelephoneNo. SEE.
$
.�, :COMMONWEALTH OF MASSACHUSETTS
BOARD d)r
ELECTRICIANS
ISSUES:THE FOLLOWING L'I'CENSE
AS A R>=G JOURN...EYMAN; ELECTR I C1/�N `�
Z
�E.ORGE N PELLETIER
N
24 WOOOHAVEN DRIVE jW
ANDOVER MA 01810-2823
36645.. 07/31/16 64240