HomeMy WebLinkAboutMiscellaneous - 24 Mayflower DriveDate .....96.
.. ....... ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............... 5
... ................................
has permission to perform ................ S F, e �4 .........................
wiring in the building of ...... .......................
at ........ A 4-- �.. eC ..... hee— ......... . North Andover, Mass.
Fee ... Lic. No.. ......... .....
QCT ELECTRICALAL INSPECTK
Check #
7086
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. -70 cT&
Occupancy and Fee Checked
[Rev. 9/051 (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 INFORMATION) Date: i 2
City or Town of: hl. To the Inspector of Wires:
By this application the undersigned gives notice of his or her i tention to perform the electrical work described below.
Location (Street & Number) ,Z r �ow e -
Owner or Tenant z L a Tel p one No.
Owner's Address
Is this permit in conjunction with a building per it? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service lel6l Amps /� rr! Z yc Volts Overhead ❑ Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
naac•n aaaurona/ aetatt J desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: %Z —_>` 44 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: INSURANCEOND ❑ OTHER ❑ (Specify:)
1 certify, under the pains and penalties of perjury, that the information on this application is true and plete.
FIRM NAME: LIC NO.: 3�
Licensee: A�s
Signatur LIC. NO.: 3 3
Nf'applicable, e #er "exempt" in the license number line.) Busy1 eT. No.' �,�7 —2/G
Address: _ Alt. Tel. No.:
*Security System Contractor License required for this work; f applicable, enter the license number here:
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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. [PERMIT FEE: $
- •. "'s
tuwe Frtuy ue watvea OV [tie rns ector" of wires.
No. of Recessed Luminaires
No. of Ceii.-Susp. (Paddle) Fans
No. ° ota
Transformers KVA
No. of Luminaire Outlets
No, of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- F,o.
of Emergency Lighting
rnd. rnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o, of Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
um er
ons
o. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ unic'na ❑Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. o aterNo.
o No. o
No. of Devices or Equivalent
Heaters KW
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
a ecommunications ging:
No. of Devices or Equivalent
OTHER:
naac•n aaaurona/ aetatt J desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: %Z —_>` 44 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: INSURANCEOND ❑ OTHER ❑ (Specify:)
1 certify, under the pains and penalties of perjury, that the information on this application is true and plete.
FIRM NAME: LIC NO.: 3�
Licensee: A�s
Signatur LIC. NO.: 3 3
Nf'applicable, e #er "exempt" in the license number line.) Busy1 eT. No.' �,�7 —2/G
Address: _ Alt. Tel. No.:
*Security System Contractor License required for this work; f applicable, enter the license number here:
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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. [PERMIT FEE: $
e