HomeMy WebLinkAboutMiscellaneous - 120 Sherwood Drive 9r,/
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3?O�_',O��D'+'.•s�O0L TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that ... ...-....�:
..........................................................................
has permission to perform
.......................
wiring in the building of...........................
. ..........................................................
at. .:.: ..................:......'."..............`......... " ... ,;North Andover,Mass.
Fee .......... Lic.No..............
..... .......................................................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
Commonwealth of Massachusetts Official Use Only
R Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 111991 (leaye blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance%Kith the Massachusetts Electrical Code(MEC),327 CMR 12.00
(PLEASE PRINT IN LVK OR TYPE ALL INFORMATION) Date: -al Q
City or Town of: Q v ex To the Inspector of Wires:
By this application the undersigned gives notice of his or her intentio o perform the electrical work described below.
Location(Street&Number) a 0 Shext4xad,
Owner or Tenant Telephone No. 8'- -7
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No �J (Check Appropriate Boz}
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No. of Meters
y New Semice Amps 1 Volts Overhead Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Com letian of the following table nrav be waived by the Inspector of JFires.
No.of Recessed Fixtures No. of Cei1-Susp.(Paddle)Fans No. of Total
(Transformers KVA
No.of Lighting Outlets No. of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ l I- ❑ o.o Emergency ignnng
b grnd. grnd. Battcry Units
No.of Receptacle Outlets TNo. of Oil Burners FIRE ALARMS No. of Zones
No.of Switches No. of Gas Burners �No. of Detection and
Initiating Devices
No. of Ranges No. of Air Cond. Total No. of Alerting Devices
Tons
No.of Waste Disposers (Heat Pump Numbcr Tons JKW INo. of Self-Contained
Totals: - Detection/Alerting Devices
No. of Dishwashers ISpace/Areaffeating KW . Local ❑ Municipal
Connec ❑ Other
tion
No.of Dryers Heatinz Appliances KW Security ystems:
No.of Devices or Equivalent
No.o Heaters KW terho. ° —o.—of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER
Attach additional detail if desired, or as required by the Inspector of IVires.
INSURANCE COVERAGE: Unless waived by the owner.no permit for the perfonnance of electrical work may issue unless
the licenses 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 ❑ BOND ❑ OTHER,❑ (Specify:)
Estimated Value of Electrical Work I qh (Expiration Date)(When required by municipal policy.) .
Work to Start: -o I Inspections to be requested in accordance with NEC Rule 10,and upon completion.
I cert,under the pains and penalties of perjury,that the information on this'application is true and complete
FMI NAME: ADT Security Services 111 Morse Street,Non o MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Si-natur LIC. NO.: 1333C
(If applicable,enter"exempt"in the license nuniberlinc.) Bus. Tel. No.• 1
Address: (E� Alt. Tel. No.: 603-594-59 resi
OWNER'S INSURs.NCE WAIVER: I am aware tliat the Licnseedoesnnihave[lie liability insurance coverage normally ONLY
required by law. By m} signature below. I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's aocm.
Owner/A-ent
Signature Telephone No. PERMIT FEE: S 3S•