HomeMy WebLinkAboutMiscellaneous - 185 Jerad Place�l
%v
C
n
ro
6.
Date... ./`�f . //...6....
° TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that t' d � e a
.......1 ^v... .................. ....�.r.............................
has permission to perform ... " e C
T �.�...............n....................................
wiring in the building of .... v..� ...... e....... ....................
at .... �_,.5)........ 21 t1. e.... .... PL ........................... . North Andover, Mass.
Fee. . v ......... Lic. No'& r ............................................................
ELECTRICAL INSPECTOR
C V If I � bA/05/98 08:45 50.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
uhe (F-omummalth of ffluBar4usaw
Eepmtritnt of Public *ufttg
BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00
Pnrmk No.
� use 0*
Oci:upsncy A Fee awcmd'
3190 peaty blerthj
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMIJI 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date v
R& or Town of NORTH ANDOV R To the Inspector of Wires,.
The udersigned applies for a permit to perform he electrical work described below.
Location (Street & Number)
Owner or Tenant _- C o1-0 /u r A Uri L c_✓T G L f /L� t/S L c P ete 3 �✓�
Owner's Address i f U S �i/rC�/ '//Git
13 this permit. in conjunction with abuilding permit:
Purpose of Building �� " ElYes, No
(Check Appropriate Box)
Utility Authorization No,k-6,0 6�
Existing Service Amps _J Volts Overhead �_j Und rnd
9 r No. of Meters
New Service Amps rho ,
9 C No. of Meters
Number of Feeders and Ampacuy Volts Overhead Und
Location and Nature of Proposed Electrical WorK i✓J I A -t_ L / h c0 Ag' f► A/Q U1_`,�
No. of Lighting Outlets
I No. of yot '.cs
I No. of Transforme(• Total
KVA
No. of Lighting Fixtures I Swimming Psoi At)cve.— tn- r
grro. — grno. — I Generators KVA
No. Of Receotacie Outlets I Of Oil E
No . arners
I No. of Emergency Lighting
Battery Units
FIRE ALARMS No. of Zonae
No. of Switch Outlets I No. or Gas=urr.ers
No. OI Ranges
I No. Cf Air C.:r.c. 'Ola'
chs
No. of Detection and
Initialing Osvlcee
NO. of Disoosats
I No.ot Heat 'O:ai otat
Pur -.::s ons •cW
No. of Sounding Devices
NO. Of Oishwaeners Soacernrea mrq inv
No. of Soft Containedeat
Deteetion/Souncing Devieae
No. of Oryers I Heating Cev ces KW
Local '_ Municioaf -
Connection ._.Other
No. of - vv �i
No. of Water Healers KW I Signs °ailas:s
Low voltage
Wiring
No. Hypro Massage Tubs ' I No. of Motcrs 70tai HP
OTHER:
INSURANCE COVERAGE. Pursuant is the requirements --t '.tassacnt.sers ;eneraf Laws
I have a current Liability Insurance Policy inctuoing Ccmc.eiec Ccerations Coverage or its substantial equivalent. YES
hive suomittao valid proof of same to the Office. YES't. VO NO
If you nave CheCKed YES. p{sase inotcate We t 1
check _ checking the appropriate Cox. type coverage oy
INSURANCE k 80NO = OTHER = (Please Scac:".w)
Estimated Value of Vactrical Work S .
Work 10 Start
Signed under the Penalties of perlury:
FIRM NAME ')46hl /A
Licensee yi,
(Exbirat Oion�atet
Rougn pig
UC. NO..��
I vUC. NO.
Address (�i lAl(�Lr�T'� � fli r A//'9ull. Tel. NO
A .
---.-rte U. el. No.
OWNER'S INSURANCE WAIVER: I am aware tnat the L:censee ^_oes not have tris insurance coverage or its suostantial equivalent as to.
quiroo by Massachusetts General Laws. ano that my signature On :nis cermit anpication waives this requirement. Owner Agent
(Plea" cnecx onet• get'
sieonone No. PERMIT FEE S d l
(Signature of Owner or Agenu