HomeMy WebLinkAboutWire Permit - Permits #12196 - 240 CHARLES STREET 2/27/2014 (3) Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned
[Rev. 111991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
FOR INSTITUTIONAL* USE ONLY
This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the
municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution
pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this B rm. Use the standard form only.
(PLEASE PRINT 17V)7VK OR TYPE ALL INFORMATION) Date:
City or Town of: Nt>t`� (�AA6VQJ_ To the.Inspector of Wires:
By this application the undersigned gives notice of the on-premises performance of electrical work by employees.
Institution G�-ektct- Sati0i A-ck-" 0 ,,C.+�-i C_
Address— P,Lt 0 cl\C,t-t Q.-S &t- c,,fi A\ (j tj e,r
Location and Nature of Proposed Electrical Work: C>44,C, CQ
NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of
same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem-
plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work,
which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali-
6,rnnv,-,Pt,nomiaal,fops for:annual I permits and require individual permits for work above a stated magnitude.
❑
Date......... . .. i 4 must renew this application annually,
v4ORT#j
fed. You agree that the log(s)will be
ova
TOWN OF NORTH A N D O V E R i property except by arrangement with
PERMIT FOR WIRING
freqzdredfor additional log locations.
person
HU
This certifies that
................. ................
...................
has permission to perform ...... z",
...........
wiring in the buil
If you intend to apply for such a proce-
ding of....... A Z,
............
.................. .......... .........................
at . .....
.......... ........................... north Andover,Mass.
ominers of Electricians)do you employ
.........
Fee
Lie.Na. iivalent staff that number includes:
... ....... ............... 0,0, , , `,%,
2,
ki PECT R
s 0 ftical employment:
Check#
leir direct supervision(see c. 141 §8)? In
�nsed individual. Limited exceptions ap-
total number and also indicate the num-
Total electrical employment: Full-time equivalent electrical employment:
Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How
many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the
number of full-time equivalent staff that number includes:
Total electrical employment: 0 Full-time equivalent electrical employment:
-Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141§8.
(Please see reverse side for certifications and required signature.)