HomeMy WebLinkAboutWiring Permit - Permits #11342 - 200 CHICKERING ROAD 207B 1/7/2013 Date . �. . . • .
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . .
has permission to perform
wiring in the building of . . . . . . . . . . . . . . . . . . . . . . . . .
at . : ... a. � •R:=. . . . . . North Andover, Mass.
Fee `" `'k . . . Lic. No. . . . . . . . . . . .,
ELECTRICAL INSPECTOR
Check
13
Permit No,
2epaphnant ol5im Setwee.4
cu. I
LI
Occupancy arid Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
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 INFORAIM RON) Date:
City or Town of: ► wv tv To the Inspector of'Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical wot-k described below,
Location (Street& Number) Zu-Qbz)
7
Owner or Tenant Telephone No'V)%Virl-l.k)o,sl
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [:X] (Check Appropriate Box)
Put-pose of Building 1111rqL S Utility Authorization No.
Existing Service Amps Volts OverheadD Undgrd ❑ No. of Meters
No. of Meters
New Service Amps Volts Overhead L Und grd Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Coinpletion of'the LollojjinL table inui,be waived by the Inspector of 1411res-,
No. of Recessed Luminaires No.of Ceil.-Susp. (Paddle) Fans [ 0.0 Total T:!�ax ortners KVA
No. of Luminaire Outlets No.of Hot Tubs Generators KVA
Above m III- ❑ I I I:,:I gI 1 11;1 iig I Ing
No. of Luminaires Swimming PooI_KtLnd. grud. Batter Units
No. of Receptacle Outlets No.of Oil Burners
FIRE,ALARMS No. of Zones
No. of Switches No.of Gas Burners No o and
- Total InitiathjgjjcLvices
No. of`Ranges No. of Air Cond. Tons No.of Alerting Devices
Heat Pump KW IN-o-.-of S—e IT--C o n t a i n e—d
No. of Waste Disposers Totals: I Detection/Alertii
%_PLV_iCes
a1
unicipal
No. of Dishwashers Space/Area Heating KW Local 11Connection0 Other
No. of Dryers Heating Appliances IGW ecuri0 Eq!L No.
1 If bevices orbiva!enL____
No.of Water KW No. of NO.OT Data Wiring.
Heaters .Signs Ballasts No,ol'Devices or�E
Wujiva en
Telecommunication's IrIng:
No. Hydromassage Bathtubs No. of Motors Total HP No.of Devices oLL
OTHER:
Attach additional cletail ifdesh-ed, or as requit-ed by the Inspector of,[Gres.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 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 R BOND ❑ OTHER F1 (Specify:)
I certify,under the pains and penalties of'perjury,that the information on this application is true and complete.
FIRM NAME:C,�t vg LIC, NO.:
Licensee......... S, 4f......./ g,
Ignature
(�Iapplicuble, ent t the license nun line.) L1C, NO.:L),
Bits. Te 1. No
Address: 4a �)s G t,%v, a�"I v Alt. Tel.
*11er M.G.L, c. 147, s. 57-�11,security work requires Department of Public Safety"S" License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hove the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one, [I owner 0 owner's agent.
P1
Owner/Agent
Signature Telephone No.
.e C_
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