HomeMy WebLinkAboutMiscellaneous - Lot 29 Campbell Forest RoadN -o Date ... ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
41
This certifies that .......... /' " "' /
10 ................................. ; .................................................
has permission to perform ................. I ......
14 wiring in the building of ............. ............... =1Z ...............................................
at ...... /.r..p . .......................................... ; ....................... . North Andover, Mass.
Fee...................... Lic. No . ............. ...................... ........... e� ..............................
ELECrRICAL INSPECrOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
-f
11
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 6��Cb
Occupancy and Fee Checked ,
[Rev. 11/991 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 INFO TION) Date: 5-01
City or Town of: N Q • /Q Q u►er To the Inspector of Wires:
By this application the undersigrWd gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) + "ao(
Owner or Tenant �lmakN 61 L.. f rl U 1 ` Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps ! Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Comoletion nfthe following, table mnv by wnivod by tho lncnortnr of 6tliroe
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑ In- ❑
rnd. zrnd.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones 3
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
to
No. of Waste Disposers
Heat Pump
Totals:
I Number
I Tons
I KW_No.
""""'" -
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal [1 Other
Connection
No. of Dryers
Heating Appliances KWecurity
ystems: ?! ,
No. ofrDevices or E uivalentV L1
No. of Water,
Heaters
No. o No. o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER... ` ..:
Attach additional detail if'desired, oras required by the Inspector of Wires.
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: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
^ (Expiration Date)
Estimated Value of Electrical Work: Q al (When required by municipal policy.)
Work to Start: • 4 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete.
FIRM NAME: ADT Security Services 111 Morse Street, Nq yo d, MA,02062 LIC. NO.: 1533C
Licensee: John S. Bassett Signatur IC. NO.: 1533C
(Ifapplicable, enter "exempt"in the license nuniberline•) Bus. Tel. No.: 781-278-1131
Address: AIL Tel. No.: 781-278-1725
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 ,3 • ��
Signature Telephone No. FPEi�IIT FEE: $S