HomeMy WebLinkAboutMiscellaneous - 343 Bear Hill Road�J
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BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 own �nkl
APPLICATION performed Iaccordance TO PERFORM ELECTRICAL WORK
All work to be with the Massachusetts Electrical Code, 527 COIR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Cate j -G> •
%* or Town of NORTH ANQOyFR To the Inspector of Wins:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant / LC
Owner's Address ` !
13 this permit in Conjunction with a building permit: Yes! No C
(Check Appropriate Box)
Purpose of Building�Y j
Utility Authorization No.
Existing Service Amps _J volts Overhead Und rnd
9 C1 No. Of Meters ��, •'
New Service Amps _1 Vous Overhead _r-
Undgrno C No. of Meters
Number of Feeders ana Ampacily .1—J4,4 ,%. ,
Location and Nature of Proposed Electrical tNorx
No. of Lighting Outlets No. cl yct -_csTotal
No. of Transformers ranslormers
KVA
No. of Lighting Fixtures i Swimming Pco, .rocve.— in. r
5rr10 _ grnc _ Generators KVA
No. of Recsotacle Outlets No. of Oil owners No. of Emergency Lighting
Sartery Units
No. of Switch Outlets I No. of Gas _urgers
FIRE ALARMS No, of Zones
No. of Ranges
I No, CI Air / alai x,
No. of O,tection and
Cris /r,/
Initialing OevlCes
NO. of Oisoosals
I No.ol Meat 'o-ai ;dealt
aur..zs -ons
,VV
No. of Sounding Oevrces
No. of Oishwasnera INo.
$OaCBrArea Healigq K` .,
of Sort Contained
O,tectloniSiouncing Oevreea
No. of Oryers ( Heating Cev,cesKW
Locar '� Munrcioar
Connection Other
N0. Of
No. of Water- Jt
Heaters KW Signs 9adas;s
Low voltager i
Wiring
No. Hydro Massage Tuos I No. of Motcrs .ota, HP
OTHER:
INSURANCE COVERAGE. Pursuant ;o ino reauuements X'.tassaccusers ;eneral Laws
I have a currant Liaorbty Insurance Policy incluatng Czrnc elec Ccerauens Coverage at
have suOmitted valid proof of same Office.
els substantial eduivaient. Y93 NO 1
to ilia YES = v0 _ If you nave cnocxea
eheclting the alp roonate cox.
YES. Waste Indicate file type at Coverage eY ,
INSURANCV SONO = OTHER = (Please Scec.`j)
Estimated Value of E!ectncal work S // (t liwation Oast .
Worts to Stan Insoecaon Oale :+ac,.es:ec: Rougn
tit Final
Signtw under the Penattrea of par_tury' J
FIRM NAME '-' �'
V��
Licensee ` ✓7 Vl L l /y%9,1'-�u S g -a: re >
UC. NO.
UC. NO..��
1 I �
A i✓ ✓
adress
lt��
Bus. 'rel. NO. s _
It. Tel. No.
OWNER'S INSURANCE W IVER: I am aware tnat Ino L:censee 1l)'.
.des nil nave au afia', ccver2g8 or its suostanual equivalent as re.i
qurred by Massacnusatta General Laws. ana Ilial my signature an :rtes =ermil aoarcatron waives this requrremsnt. Owner Agent
(Please CMcx onel• ens
itoonons No.
l
PERMIT
•- (Sgnalur, of Owner or Agenn
FEE_
s�Y,
W.1 c�. L r Date ..................................
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
Thiscertifies that ............ ........................... .................................................
has permission to perform -
wiring in the building of ........ `.. �`^ �....... j. .. ..............................
.....
j ....................................................
. ................... . North Andover, Mass.n
Fee2n... ......... Lic. No .... ...............................................................
ELECTRICAL INSPECTOR
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WHITE: Applicant CANARY: Building Dept. PINK: Treasurer