HomeMy WebLinkAboutMiscellaneous - Exception (510)o 3014 Date ..... 3 /
%``° '• "� TOWN OF NORTH ANDOVER
Ile p PERMIT FOR WIRING
This certifies that ..<",.A Gl vd e 0?�- "1. �°G
...............................................................
hwopermission to perform Se ei
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wiring in the building of ................................................................
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at ....... ...., I..E �. .��!. ��. a E. ...... , North Andover, Mass./]
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Check # L�
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use Only��.1/
�:1� C�mmun�uettiitts�ttluPt Permit No. ((��
fElpaYt ent of Public fiifetg Occupancy ,& Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3/8/01
City or Town of North Andover To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 10 Stonecleave Road
Owner or Tenant T.aur i e__Ki.1by
Owner's Address Same
Is this permit in conjunction with a building permit:
Purpose of Building residence
,Existing Service Amps _J Volts
I/New Service .Amps _� Volts
I
Number of Feeders and Ampacity
'les ❑ No 5d (Check Appropriate Box)
Utility Authorization No. _
Overhead ❑ Undgrnd ❑ No. of Meters
Overhead ❑ Undgrnd ❑ No. of Meters
Location and Nature of Proposed Electrical Work remove and .replace entire service entrance
raceway and wiring
No. of Lighting Outlets
9 9
No. of Hot Tubs
`� Total
No. of Transformers
KVA
No. of Lighting Fixtures
Swimming Pool Above In
11g,nd. ❑
grad:
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
Battery Units
s
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Ranges
No. of Air Cond. Total
No. of Detection and
_l
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Dishwashers _
Space/Area Heating KW
No. of Self Contained
Detection/Sounding Devices
No. of Dryers
Heating Devices KW
Local Municipal
11❑Other
Connection
No. of Water Heaters KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No. Hydro Massage Tubs I
No. of Motors Total HP
i
v 1 19tH:
INJUHANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liabi!ity Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ 1
have submitted valid proof of same to the Office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE IR BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ 700.00
Work to Start 3/8/01 Inspection Date Requested:
Signed under the Penalties of perjury:
FIRM NAME Anda 1 t
Rough
Final
(Expiration Date)
v r LIC. NO. _14302A
Licensee Ebert. J Branca Signature LIC. NO.
Address 206 Andover St, Andover, MA 8 0 Bus. Tel. No. 0978 )475-4995
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent �A5
(Please check one)
Telephone No. PERMIT FEE $ Pls. Advise
(Signature of Owner or Agent) -
x-6565