HomeMy WebLinkAboutWire Permit - Permits #12769 - 61 ESSEX STREET 9/25/2014\KII
\ \
to o
His
1151
,
Date166
...,.. \o
so
RTT
EO
OAo .QTOWN OF NORTH ANDOVER
`
NMI 1
Al
PERMIT FOR WIRING
El 00
1001
C,Al
a `
V VEll
-\ `
r
This certifies that ., ......... ......... ...:. ......f
ME
has Perniission to perforin
Mrs
wiring in the hurtdin o
T
at f
\\ ... r .., . Al....onzinog ........... . North Andover, Mass. NEIRS
�\
Fe
Lie. No. Ell
Vi .........e...., .., s_... .d....... .......
g\
ELECTRICAL INSPECTOR
V IV
Mi
In ZEN\ Check -\ A ME
c\\
\\ � \ VV
\M
\� \
VU
\" -
Official Use Only
Commonwealth of Massachusetts
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS I[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527CM 12.00
(PLEASE PRINT IN INK OR TYPE ALL L INFORMATION) Date- L -7
City or Town of: NORTH ANDOVER To the Inspector q Wires:
By this application the undersigned give .notice f his her t t. t fprm thellectrical work described below.
Location(Street&Number) W X,-!, !; e X —
Owner or Tenant
1 17 ee, , ' /7 Telephone No.
z2a, Oe-s ,I"r:�-
Owner's Address 611,
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building 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: IA"
A-)
Corn 42f waived 1611owing able may be aived hy the I
M nspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Sus p.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above 7 In- No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. grnd. F❑
Batter v Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
f
No.of Switches No.of Gas Burners No.o Detection andTota Initiating Devices
No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices
Heat Pump um erJ,Tqps. IKW No.of Self-Contained
No.of Waste Disposers I I'Totals: Detect io n/A lerting Devices
No.of Dishwashers Space/Area Heating KW Local❑F1 Mun'c'PP' F-1 Other
Connection
,see I urity S ste.ms:*
No.of Dryers Heating Appliances KW No.of Levices or Equivalent
NO.of Water KW ivo_.O-T No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Eguivalent
No.Hydromassage Bathtubs No.of Motors Total HI Telecammun�cat►ons Wring:
OTHER:
Attach aciditional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: )e�
i (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 [_1 BOND F] OTHER ❑ (Specify:)
I certify,under the pains and penalti -ti/*perju�y,that the information on this application is true and complete.FIRM NAME: 9 'lei zi LIC.NO.:
Licensee: Signf L LIC.NO.:
(ffopplicable,enter "exempt" he I- ense nu r line.) Bus.Tel.No.:
Address: t 1 110 7A� Z15.'e- - 11 — Alt.Tel. No.:
*Per M.G.I.c. 147,s. 57-61,security work requires 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 the(check one) R owner El owner's agen .
Owner/Aizent
Signatur��' Telephone No,.:o� [PERMIT FEE: $
J'he Commonweaft vfHays huselfs
Office o,fflivesfigaflops
00 WasUngtow Stred
Rostov,AM 02111
Vwlp.wa'YN.g0 . dla
` Q'Vke)C,qi CO) .powation)[m xameAffidavit:
bmaflon
�.�►1.�(��s%�essldxgard'za�iaxif�nidual}: � .....•. __._,
Ara you.an employer?CAeek ki3 appx'aPxzato'hox' 'Cypa (reguiret1):
L. ( 1 am a amployex with ___._, 4. [I I a-m a general contx'actor and 6. � New con�titnctzan
employees T 7. El Retmdeiing
(�cr1l an�Cax part thn e T hay Xre d tho �b-conf ac�axs
2—El I aco.a solo propxietox or
listed antha attached sheet°
Th
ship
an�`�aa�ono.emptayees, es esul�-co�.txactaxs b:ave
8. �:C�en�•a�.tlon
woildhg forte in.a-ay capRr*y. workers'comic,insurance, 9, El Bnzfding add7tlon
[To wor ers' can%p. sraxance 5, Q We aro a corporatgrt and zts Ja.El B£ectxzcalxepairs ox uddit'low
xecp died. of zcers have exerels0dtheir
3. axe a lzc��reowner q g aliwoxk right of exemptionporMo, 1,. ()'Zurnbingxepairs ox adcl�om
rayseZ<L90wor7rere comp. r.152,§1(4),andwohaveno ?2,q poof'xepairs
; ant re ed, i employees..D7'oworkexs' aEl pthox
�` � comp,msnxanee regrdxed,� •
Any applicaaitbai abacTcs boy#Z mvsaiso fill ouitTzeaatiou below shaving tbeir arbzkers'com�ensatiaualz'c infamTaiou.
iomeo�tuers who submftbis afftdaYitindicating#lieye doing alZvrarkandtheuhirc outside contractors musi submit anavr afFtdapiindicang sixcfa.
xdantraatars�bai ch�ekibssba mrisUatEached addit"ranaisbeebsho�ingiheuarrzeoftl suh coniractarsandibeiiv�ozicazs°enmp. alicylnfazmaiiort.
Jtwavem cry r�tXi�retisp ovztCirag o Xte *ca�rtpe�a atio�� r��r� icy o ,eye Xoyees�, erow tXie a.Xicytcr2 0 site
k2 ance Cosa sarzy arae;_
ko7iay 0 ox Sel.�js<Yxc.#;
�'ab�ite.�.cldxeu�� .� ��` � _.--- CityCStateC�ip: �':� �;�, " •. �
ttaeh,a copy cs tlZowoxf e S'eazxt ez�satiox�polzcy cleclaralloxlpago(sho' g•th wafloa cafe).
�a�tare to sec��covexage as xecl�ix'ec�.nndex�eation 25.�.a��G�a.l52 aan lsad€o the imposiEian,a�eiimi�:al�enalties o:e"a
$ne to X,50O,f1Dand/ox ne�yea zmpisa xtent,aswellasazvi[pexaltiesiittlzefaxrao a STOP O O)RDERaida we
oE-U.p to$250,oO R day against tb Aolato:r. Be advised that R COPY lD9f ss stateMextra.a.�'ba ftwaZded to fhO OfEGO Uf
7iavestigations of tho DTA fox IManca coverage verification,
Xie e it ce zfy ticC pc ire e�'of ef" ar�u Brae izg�ar�zat��o�a�YovirtecX tiboye is�zre ancX eon
` ature` Data:
Thong :
G�f ici Z sY a Xy. .Do nol wife in Alls area,to be cowXeted by city oplom o cuff:
City or Town: J es.-MztlECextso#
sing ci orz�y(Wclo ono :
Z.Board+ol �teaItl� �.Bn�Sclzn��epan��no�nt �.CAyA'am Clerk 4.Elechlealfugedor S.B,lumbiligbispeefor
6.L7tlzer - - -
V'.CQMMONWgALTH 4F M*�� HUS�TT:
�xf
5
a e