HomeMy WebLinkAboutWiring Permit - Permits #11547 - 287 CHICKERING ROAD 4/30/2013 i
Date..... ...................................
NORTH
o�,,�•� r.'ti TOWN OF NORTH ANDOVER
j ° 9 PERMIT FOR WIRING
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This certifies that
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has permission to perform ��.. ���: � ..........
wiring in the building of............ ..............................................................
-A i North Andover,Mass.
at .....�:. ... ...............................................� ,
Fee...t.: . Lie.No. ' ...�.. �:........ ....................................................
.... ........
ELEC-MCAL INSPECTOR
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Check# f� kt
Commonwealth o f Mamac4woth Official Use my
o[Je arfinenE o p�ire�eruice� Permit No.
P # I
Ot:cupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Re"- 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 N INK OR TYPE ALL INFORMAT ON) Date:
City or Town of: r To the Inspecto of Wires:
By this application the undersign gives notice of is or her inters'on perform tl;e electrical work described below.
a Location(Street&Number) �C \ (�
00 .0 °�� Owner or Tenant 9 l,/ Telephone No.
aU
4) a Owner's Address
o E_ c c Is this permit in conjunction with a building permit? Yes L2 No ❑ (Check Appropriate Box)
0 3 < (u Purpose of Building Utility Authorization No. u
Existing Service �— Amps Y�GYolts Overhead Undgrd❑ No.of Meters
aai .c.: o o New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
7a o° a) u o Number of Feeders and Ampacity
U U C w V
a)'0 o w Location nd Nature of Proposed Electrical Work: r l-e �{'
ati t~n c
— at u_ Completion o the ollowh. table m be waived b the Inspector o Wires.
2 v° � m o.of Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ - C� o.o Emergency Lighting
.1�1nd. nd. Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.o election and
Initiating Devices
No.of Ranges No.of Air Cond. Tonsi No.of Alerting Devices
Heat ump _.......... er ons o.o el- ontained �
No.'of Waste Disposers •--~--- —---
p Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local❑ Connection
❑ Other
P g. Connection
No.of Dryers Heating Appliances KW Security Systems:"
� i'Y No.of Devices or Equivalent
c No.of Water No.of No.of Data Wiring: �•
N KW Ballasts
Heaters
Signs No.of Devices or Equivalent �S
e ecommunications 'ring
Q No.Hydr-omassage Bathtubs No.'of Motors Total HP No.of Devices or Equivalent
0 OTHER:
o c Attach additional detail it desired or as required by the Inspector of Wires.
'-' Estimated Value of Electric Work: (When required by municipal policy.)
o Work to Start:--- / Inspections to be requested in accordance with I�IEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the peribrmance of electrical work may issue unless 3
mM the licensee provides proof of liability insurance including"completed operation"Coverage or its substantial equivalent. The
E undersigned certifies that such cove a is in force,and has exhibited proof of sam Y to the permit issuing office. l__
CHECK ONE: INSURANCE (BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains nd penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: <, 7ef' f _ LIC.NO.:
Licensee: / Gl°C(i .!`I Signature I
� — LIC.NO.:��-
(Ifapplicable,enter 'exempt"in th license n�+/►�ber line.) / / Bus.Tel.No.•.�'�5 S l`kJ G
Address: ��)�/ 4,Ll i2 f l 4/C/-, r�C��G 2, i Alt.Tel.No.:-;��1 I7l S T �
*Per M.G.L.c. 147,s.57-61,security work regd es Department 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 tf..a(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $.-_
Signature Telephone No.
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LICENSEE
Name:DOUGLAS G. DAWKINS REFERENCES&
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Licensing Board: ELECTRICIANS
Glossary of License Status
MASTER ELECTRICIAN
License Type: Codes
TYPE CLASS:A
License Number: 21545 Moro
Status: CURRENT
Expiration Date: 7/31/2013
Issue Date: 5/17/2012
Exam Date: 5/17/2012
School: WHITTIER REGIONAL VO
This web site displays disciplinary actions dating back to 1993.
This license has had no disciplinary actions taken during this time.
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