HomeMy WebLinkAboutMiscellaneous - 744 Winter Streetv
Date l..-..2. ...... 6.3...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....
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has permission to perform... ..............................................
wiring in the building ofcccy
....................... ............. . . !?n .........................
at ...... 7Y.Y........
V ........... ,North Andover, Mass.
....... .............
......... ....... I....
ELECTRICAL INSPECTOR
Check #
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Official Use )nly
Permit No.
VO4V-e-t Pdt& sem/ Occupancy & Fee Checked Jam► I
BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 52 CMR 12:00
(Please Print in ink or type all information)
To the Ins or ofWires:'
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number 11 . / / v •
Owner or Tenant)
Owner's Address
Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box)
Purpose of Building s l dl
EAsting Service Amps Voits Overhead ❑
New Service Amps VoitS Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical
Authorization No.
Undgmd ❑ No. of Meters
Undgmd ❑ . No. of Meters
OTHER:
-A
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 h trent Liability Insurance Policy including Completed Operations Coverage or its substantial equivalen YES NO =
a�S�Zlvalid proof of same to the Office YES = NO = if yo►t h check ES please indicate the type cove a by checking the appropriate box
INBOND =OTHER =_(Please Specify)
p! �Y/Ii7
Ese of Electrical Work$ Work to Start Inspection Date Resquestedough Final
Signed under the Penalties of perjury: ��� <' LIC. NO. 6'
FIRM NAME
dl----- C J P" �j Sinnature LIC. NO. - -
L� 3 -e�S,5 /
Bus. Tel No. v
Address
441� It Tel. No.
OWNER'S INSURANCE W YAR: I am awa f e hat the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on thpermit application waives this mqulrement. Owner Agent (Please Check one)
Telephone No. PERMITTEE SS— - OD
(Signature of Owner or Agent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑ In ❑
No. of Lighting Fixtures
v
Swimming Pool
gmd ❑ gmd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
�v
No. of Oil Burners
BattUnits
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
*
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Di sal
No.
Pumpp Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
SpaceWea Heating
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Wirt ng
/ 2-00, U
No. Hvdro Massage Tuds
No. of Motors
Total HP
V
OTHER:
-A
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
1 h trent Liability Insurance Policy including Completed Operations Coverage or its substantial equivalen YES NO =
a�S�Zlvalid proof of same to the Office YES = NO = if yo►t h check ES please indicate the type cove a by checking the appropriate box
INBOND =OTHER =_(Please Specify)
p! �Y/Ii7
Ese of Electrical Work$ Work to Start Inspection Date Resquestedough Final
Signed under the Penalties of perjury: ��� <' LIC. NO. 6'
FIRM NAME
dl----- C J P" �j Sinnature LIC. NO. - -
L� 3 -e�S,5 /
Bus. Tel No. v
Address
441� It Tel. No.
OWNER'S INSURANCE W YAR: I am awa f e hat the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on thpermit application waives this mqulrement. Owner Agent (Please Check one)
Telephone No. PERMITTEE SS— - OD
(Signature of Owner or Agent)