HomeMy WebLinkAboutMiscellaneous - 5 Woodberry (2) 5 WOODBERRY
210/038.0-0142-0000.0
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Date.. ..........
.6 6
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
14—
This certifies that ........ ..................... .................
has permission to perform .......................
wiring in the building of....... .... ............. ..................................................
... ....... ........ North Andajo ,'Mass.
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Fee .;. ..' c No/47 .. ... ....
..... .......... .....ELECTRICAL R
Check # Ie3
8030
�AUAa►iwea�tfa o� a ac t Official Use Only
2e a,6.At Jim Services Permit No �� Gr
Occupancy and Fee Checkedl
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/071 cave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00
(PLEASE PRINT IN INK O E ALL INFORMATIOII9 Date: '
City or Town � � To the In pector f Wires:
By this application the un ersi ed fives notice of ' Pr her intention o perform the electrical work described below.
Location(Street&Number)
Owner*or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ . No ❑ (Check Appropriate Bog)
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: ���y ,.{��2 bei, ✓V\A
Co letiox o the ollowin table m!M be waived by the Ins for o fres.
No.of Recessed Luminaires No,of Cell.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No,of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o Emergency Lighting
nd. d. Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.If Det ction and
Devices
No.of Ranges No.of Air Cond. Tota No.of p!erting Devices
No.of Waste Disposers Hestrump.. Number ons o.o Self-Contained
Totals: �" Detection/Alerting Devices
f' pal
No.of Dishwashers Space/Area Heating KW Local 1:1 uniectio ❑ Other,
Connection
t No.of Dryers Heating Appliances KW Sectio.of Systems:*
Devices or Equivalent
No.of Water KW W0—.o f o.o Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring::
No.of Devices or Equiva1lent
OTHER:
6 Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electric Work:L:i . (When required:by municipal policy.)
Work to Start: S Inspections to be tequested in accordance with MEC Rule 10,and upon completion.
INSURANCE OVERAGE: 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 pov rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEBOND ElOTHER El (Specify:)
I certify,under the pains and pen�alties oj^perjury,�thatt the-- information.on this application is true and complete.
FIRM NAME: "�J `fit✓�I ���� � LIC.NO.:
Licensee: Signature-4 CJd L,1 -LIC.NO.:
(If applicable if t"'n th 11ce3qe be-lin ) Bus.Tel.No.•
Address: U 30 7 Alt.Tel.No.: 8 . o
/
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: X 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)[:1 owner ❑owner's agent.
Owner/Agent
..SignaturTelephone No. PERMIT FEE.$� ,y