HomeMy WebLinkAboutWiring Permit - Permits #13013-1 - 595 CHICKERING ROAD 1/12/2016 X
Date--Z.-.
TOWN F NORTH ANDOVER
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This certifies 6.kttdt
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has per on tar g�arMa�Bonn .......�°' �
wiring in Cuc building
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COMMOnwealth of Massachusetts Official Use Only
Permit No,
Department of Fire Services
Occupancy and Fee Glecked
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfornied hi accordaace with the Massachusefts Jjj c
a trical Code(2Q,1.11 CMR 12.00
( 'ASTPRI 'EALL JAW01 YYO)V)PM 1YY'1ArJArK OR TY1 WA Date: / v
City or Town of: NOWHI ANDOV.E.'R To the Inspector of Wires:
By this application the undcrsig�_ej' o perform the electrical work described below.
I
Location(Street&Number)_._
Owner or Tenant
Telephone No.
Owner's Address
Is this P crin it In conj 1111 cti oil with a b u I I di ng p erm it? Y es
No F.1 (Check Appropriate Dox)
Purpose of 'Utility Authorization No,
Existing Service Arups -_--volts Overhead IJdgrd No.of.meters
New Service Amps Overhead Undgrd No.ofAleters
Number of Feeders all(]Ampacity
..........
E lWoAC A
A'Location andNature of o s
....... Wng table tagy or 0 Pes.
_be waived by Inspect
No.of Luminaires No.of Cefl.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Cencrators KVA
'Wl
Na. fLuminaires Above —n- r-g-C-11-CY-1-1gy1fl-ng
70 swinlorillgPool rn"d.
Units
No,of Recessed Lu
No.
of Lu"linaire
N 0. ire,
ElDfLumina s
0'of 0
No.ofReceptacle Outlets No.of Oil Burners FIRE Ala%I i il No.ofZones
No.of Switches No�of Gas Burners Na.6"Detection and
Na:N 6 I Ba
tter
0 r 0-
—0 0 r-A
a t
0
L
I A
r
e I Un
its
-t g
C e F
0
0 0 f------L------
N f te I Incl n
Init 2 tin Devices
i . '
if v'c's'vl'c
io
Ill I tra De
No f ert_
0 Al "191)
No.ofRanges
No.ofAir Con d. Tons No,of Alerting Devices
t IIIataal No f i,
(!I r'—self-cont'jocT
No.of Waste Disposers �. .eatllu,liT-Kiii4k Toi
Totals
. /
02
1 1:
ota s n,
tin le�i
D til I J Detection/Alei _)evices
M
M.
C I nicip
ctlon
Na.ofDishwasheri Space/Area its siting KW LocalEj U�"110 0 other- fpg
'onflection
No.ofDryers Ifeating Appliances KIV
r Egpivalent
N 70-4-Water --------- No.'F)f _No,of Devices o
Heaters K Data Wiring:
Signs_ Ballasts
.......------- No.of!Djc'v�jces o Equivalent
No.Flydromassage Bathtubs No.of.Motors 'GlWommunications Wiring:
rotal tip
No,of Devic........... ,�uivkle�llt-
OTHE R:
by the Inspector of wires.
Estimated Value ofElectrical Work: _rl,�-e7,2-jf Tdesired,'01'""e'
(When.required by municipal policy,)
Work to Start: hIsPections to be requested in accordance with MEC Rule 10,and upon cornpletion, ..........
INSURANCE CO-V waived by the owner,no permitfi,rr the performance of electrical work inay issue unless
the licensee provides proof'offlability insurance including"cone pletud operation"coverage or its substantial equivalent. The
undersigned ceitiffes t1I such coverage is in force,and has exhibitedproofof&nne to the perinit issuing office,
C1lFC'K ONE: INSURANCM Ej B(,),IIZD 17
ru� (Specify:
Iceftitil,lender the pultisaiidpefzizltlesofpeijtiiy,that the inforinati011 oil this,al)pfication is true and coinj)[eie.
YfRM NAM F: TAC.NO.:
LIC.NO.: E-�3/6 S"S'
le,ent prul Mer Tel.No,.see: Sig
fa Licart ap
plicable 7 je,� natiire L A t
o
Address:
�t 61,security work requires Dopariiiient_ zcense: No.:
*Per M.G.1,c, 147,s 57 Alt.Tel.
Lic.No.
OWNER'S INS URANCE WAIVJ?jt: I till,aware,that the.Licensee does not have the hability insurance coverage normally
required by law. By iny signature below,I boreby waive t1tis requirenrent I am the(check one; E-1 owner D owner's agent.
Owner/Agent
Signature ........ Tele 0 e No, ITTEF $
WORP/A/1 /9111
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Tile conunonwealth of Mitky(whuseftq
lAcclelents
M I f:.longress rS"treet,,S"x il� 100
Boston,MA 02.1,14--2017
�ttl�l��rcr�w tau/itrcz
y µaWorlae:rs'Comps-nsationinsuraaaedAfflilaaxt l3uilc�ea !(cants staxsl lectx .ci s/i'turxrtrexs.
TO:FAk:Fit:aLJf�'1Tt'El7`t1rr:F' .t: 1 t.CI�SUt (-C�t t?leaasc 'r^irat Le '1r1
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A ''Ircarntlnforrnation
Nameusaness/Ctr�rna�atarrxa(.tudrvtshaal'
Address:At
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City/St�rt�.0.�
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a of ro ecf(,required):Ncw'roarstaucticaaa :
Are you azs employer?Cho k tixu slsllro;rsrlaa&c C axa r
1.El t at"aemployer with
ernlr?}"r,e (Lir ill am3Pcror lr r tirxro).
t
ra eployra xn
or sa ]rtsv Wr
ry,F t am rrole proprietor
p i caxaociclln o
any capacity.[Noworkels'cornp.trz rar'anrc xeguixecLJ 9. �Demo�,tton
3.ElIamahmxeowaesdarn all wuskrnysc8fgtic+weryers u)rrip.iastanna.arr'rtzurrcrt.l'r 10 jBuildiog,addition
4 �T am a horrrcowsraa Mid wig lro hra iax contra[fors to conduct atll'wozk On MY l l ' y'1 Will _
� irrr ar at
1.. tCctz}z11c,,�Llrpaasarctcl�ltirlasr'
ensme that'711.contractors el,ther llfil�wo w+o'rkerr Comp4rlJ'ltil)ii kYrSllydrl6P(71'^rrTC '�"r.%le ���� p�;1'�fn.�r.tlg repairs or additions
proprietors withrro dinployees.
5, 'these snb c c ntrac o�s ha ve to la e ail€t a uL-curate rclox lrsRecl air tlaaa atE&ash,ri;3lreiasV:.
1 L__112.b6freprtlr5 l
& we are cr7r oration and lts.offiucrs lruue�excrczsed their rrt lzt o[er nili iol
ersr�:rlo ees. Vo vdcr�keas cr u.rarnp.rnsurati 1�,["�47Glaer__
�� ' rtronprc ](tL€
p comp,ixz uranc e required.]
152,§1(4) rndwez have sra l Y p
��nYa'pPlicantth�tc}_'cicsbax,jaraatalsrift]lrrutthBscotioribel.owshowiiigirewworker,r carupczaatronpolicyi[Ijoavrrtsarr.
i ilorncowners who,ubrruC-this aCiiclavrl sr r.3idanxkzaddityan t h are Aet rlaawzn rg all work,]rylvracrre hire
ot floes sP)emAr cl or'.^z and r4 tp wlz th reo,raft t those,entitleshavc it
tCaar4racfara that shot le tkur lrox xni rst attache
i
employees. Ift'he ukr-aontrae lrxe.,]rave arnplayce kkrcy rrzut>t provide th n W leers ccrrralr lrulrr Y rauu l nr
I am an employer that i Pro Pitting t^uordu:a rv'";OJaz��rx�rx��rrrt rra�r,�a^crarr�fnr my a rva�al%rye c . below�s the pajt',a:,y ar2cdjali site
lnfbrination. t5 t
Txnsr.rranca;CorrrinarzyNaaiao.,_.___-. _..._.
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17:xiaatataarrr.i7dtc� �_._ _.__
laolicy##or Self-fits.Lac It:
Tcita Site Address. ..1 _. �° _ _ .
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Attach aco, ofdetworl€eas corupa:>]nsaf'ra .olzc, cle;cl�raalanr page � rd7n auaa> .alilelncraxaclerrprxateoradate.
� y y tT (siro�rrraxg ISrr7 policy rrrrraa
pY b a fuab u r to$1 50O,17(1
Failure to secure eeavatat e as n equireAl.under NIC��rI c 15 , JSA is rrnaran.nal vtolat' p y K 1
tic;laho fond,o r the CJ f c c) CK(�ta)< ian of the l)"1A f to d"1,5Q,(.l0 ar f
1
and/or one-year h aprison eart a wcl'�a �.t tale penalties h rzr kr t de t rr r�x or lrnsraratinaa
a against aainst the violator, A.copy of this s�tateraacot In Y i
coverage
X clo xrE r�l�vr ercaeGrlc ttn
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tree and correct
nlNti .
ze sxnrperatliesrr are �v b.5
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F7h�e#apt only. .!)crnot-write zaz P/azs szrr.cr,to be completed by city or tow"_ otfl(drrl, 0,
City or^['awn _
-
issuing;Authority(circle c.le airs.);
1.Board of Ileahl, 2.Buildin.gw Departanent 3.City/"Yowrr Clerk 4.f;lectrical fnspector• 5.Plumbing Inspector
f
6.Other_ _--_._.....
Phone ll
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Contact Person: -
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