HomeMy WebLinkAboutWiring permit - Permits #12413 - 59 BERRINGTON PLACE 6/19/2015 If n onweah4 o f Maseac"M Official Use Only
� L`"1�'���
2eparlmenl o��ire�erviee� Permit No.
Occupancy and Fee Checked
Ulu 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(ME ),•27�MR 12.00
(PLEASE PRINT IN INK OR TYPE LL INF RMATION) Date: ��ll
City or Town of: M AAFII� To the Inspector of Wires:
By this application the undersigned gives notice of his or er intention to perform the electrical work described below.
Location (Street&Number) JP_�
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 �h1 I� 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:
Completion ofthe-following 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.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting
rnd. rnd. Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.of Detection an
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
No.of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained
Total ................... ........... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances }fit SecuritySystems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring•
Heaters Signs Ballasts No.of Devices or E uivalent
No.Hydromassage Bathtubs No,of Motors Total HP Telecommunications NDevices
r Equivalent
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by-the Inspector of Wires.
Estimated Value of flectrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
,a the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
H undersigned certifies that such cover office.
ge is in force,and has exhibited proof of same to the permit issuing oce.
CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the injortnQ on on this application is true and complete
FIRM NAME: .C� I C LIC.NO.:
Licensee: V �/` Signature Mo AL LIC.NO.:_
(If applicable,enter exe pt"'n t e lic nse number line Bus.Tel.No.;
Address: Alt.Tel.No.:
*Per M.G.L.c. 147,s. 7-61,security work re ices Departmeni 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)❑owner ❑owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
Town of Andover
Massachusetts
36 Bnrtiet Street Electrical Insl
` Andover,MA 01810 Paul Kennedy 978
ELECTRICAL PERMIT FEES Fax Number. (978)6.
(revised September,2012) Office Hours: 8.00 a.m.- 10:
Commercial Base Fee S50+
Sl each device
Residential New Dwelling Up to 200 amp service S225
Each add. 100 amp's ` S20
Multi-Family New Condo/Multi-Dwelling(per unit) rye -
Residential- Service/change/attenitioas i phase-200 amp S60
Multi-Family/Single Family 3 phase-200 amp 5110 _
Each add. 100 am Vs S20
Additions/Renovations/Replacements (Maximum Fee S225) S50(min.fee)
Outlets,switches,plugs, luminaires,eta - S 1 each device
Residential/ Appliances• S50(min.fee)
Commercial(S50 base fee+) SIO each appliar
Air Conditioning and Heat Pumps S�0
Temporary Service S50
Residential Generators/Solai Panels (service additional cost) SI00(base fee)
Additional S25 each
Commercial Qenerators/Solar Panels (service additional cost) S10O(base fee)
Per KVA Sl+
Additional Equipraient S25 each
Residential Audio/video/deta/phonasystemst S50
Fue alarm/security systems
Commercial Audio/video/data/phone-systems! S50 base fee+
Firm alarmisecurity ems S60
Commercial,- New Construction and Ab=doas Base fee S50+
Per 1.000 sq.ft.of Construction Spam S100
Service/Change up to 200 amp S150
e Elecirfcal I ar or price above 200 am
Maintenance Permit/Repair Blanket Permit(up to two electricians) S200
Over two electricians(per pair) S50
O1Eoe Furnishings/Partition Relocations S50.00(base fee)
Per Circuit S10
ransformers(non-utffl owned) S50
Miscellaneous Carnival tides S50
Demolition S50
Feeders or sub-feeders and panels S30'
each 100 amp.capecitor&action thereof)
`n Motors, h or fiaetionat art thereof
� Set
Sider (re-securin serve lights,plugs) S50
Signs S50
jY, Meters S20
Swimming Pools In and S100
Above-Wound S50
Commercial S200-
General Fees Re- on Fee $50
lInspection after hours(minimum fee) S200
Date `
..........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
CHUS�S�
1 6
y 6
This certifies that5 � �� '
......,.... ......... ......................... .:...........................
has permission to perform ...e �' �s �
wiring in the building of p r �
r 4...........................................
1�
at
F....r� .....�., e.. :..�� e v � � ..:....,North Andover,Mass.
r C
Fee..........—e.......... Lie.No a: �. .. .�.� .4' / .............�
.... ..................... ...........
,.i ELECTRICAL INSPECTOR
Check# 21�S