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Home My WebLink AboutWiring Permit - Permits #13013 - 125 LANCASTER ROAD 12/23/2014 Date...........�......... ... s� �NORrhAtiooG TOWN OF NORTH ANDOVER I PERMIT FOR WIRING 88ACHUg� r p '� p i This certifies that ......... ...... ...b'........•6 ................................................... t ..................... has permission to perform FF ^^ /� ..........................(5 IN2 _. ....................... in the buildingof . ,..� � � � a North Andover,Mass. at :: �""i��'C� j �� Tee...:.. fit.... :.......Lmc.No. e� a� ............: .. EL CTRICAL SPECTOR Check# - ec.ieNurcaceru or ✓cre j BOARD OF FIRE PREVENTION REGULATIONS Rev.1107upancy and Fee Checked � ] (leave blank) .) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),52,7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE, //ALL INFO��TION) Date: /� -;13 �G City or Town of: (/VJ�� NI�/(�✓-P-- To the Inspector of Wires: By this application the undersigned gives notice of his or her iptentioon to perform the electrical work described below. Location(Street&Number) � Owner or Tenant r �C � -� S� ,Y �k/�• Telephone No. �79V -13 M) Owner's Address � ,- Is this permit in conjunction with a building permit? Yes ❑ No jO (Check Appropriate Box) Purpose of Building Utility Author tion No. Existing Service v�0' Amps %20 /,/�)Volts Overhead ❑ Undgrr No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of.Feeders.and_Ampacity_ Location and Nature of Proposed Electrical Work: Com letion qfthefiblloii,ing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.ofLuminaire Outlets No.-of Hot-Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency rg rng rnd, rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE 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 g Tons g 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 [I Other Connection No.of Dryers Heating Appliances Imo' Security ystems:* No.of Devices or Equivalent No.of Water KW No.-of No.of Data Wiring: Heaters Signs Ballasts I No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: �i Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Vim" (When required by municipal policy.) Work to Start: iJ L 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 certifj�, under thepains and penalties of erlurv,thfit to informatfou oft this application is true and complete. FIRM NAME: ! S lF/ ci Y t' �� 5 GLC LIC.NO.: I 7OJ ✓`� Licensee: J%lCi, �� h �/ Signature �2 " LIC.NO.: (If applicable,enter "exempt"17 the,h ease number line. l Bus.Tel.No.: �'6'%"v1OV Address: �l/�l fu /<c�;c��/(/or74'� �n�//r�h% ��r �l�y� Alt.Tel.No.: `�'l *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lie.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. $ i Commonwealth of Ma usetts Division of Registrati Board of Elect ri k MICHA W 9 WAVE _ o NORTH A Master Elec 'a �w 21705-A 07/31/2016 .o�M vev008772 License No. Expiration Date. Serial No.