HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (36) F �p
N° 2648 Date....,�. .. ...� �
Y t NORTH,
TOWN OF NORTH ANDOVER
A PERMIT FOR WIRING
�,SSACHU$
This certifies that .........1
V. ....!..r..........;-..... .C........ ........................
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has permission to perform ....... ..�.aL�.! !.r Z S �/ .. c.....................
wiring in the building of.........rl .t.�
at...............:�..G.. .1.. ...................................e,North And er%Mass.
Fee..��..U...� Lic.No.:./ ....... . �t�...���.........
ELECTRIC AL INSPECTOR
Check # �1 `��
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
The Commonwealth of MasSachus=S Office Use Only
DeparrM07r of Public Safety Permit No.
BOARD OF FIRE PREVENTION REGULAT70NS S27 CMR t= Date Issued:
- —19
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All—k to be Pel" ed In accordance with the Mas:achusetu FJt=cal Code. 527 r-MR 12.00
(PLEASE PRINT IN nM OR TYPE ALL =OMJ&=ON) 'Date
City or Town of /1/o�.- z
To the Inspector of Wires:
The undersigned applies for a permit to perform the electric-al work described below.
Location (Street 6 Number)_f�i2�o K e, /4 6 l
Owner or Ienant ,Q 0 Q vj S S C/yC3U [�
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ NO (ick Appropriate Boz)
Purpose of Building cN7Z't Utility Authori:atioa HO.
Existing Service A... i
New Service Amp p Overhead Clundgrd Lj No. of Meters
�-' Overhead Undgr s / Volts O ❑ d❑
s No. of Meters
Number of Feeders and Ampacity '----
Location and Nature of Proposed Electrical Work A
G /N
No. of Lighting Outlets !b, of Hot IubsTool
No. of Iransformers Tota
No. of Lighting Fixtures Above
Swimming Pool
grad. El Md. 11 (Generators XVA
No. of Receptacle Outlets No. of Oil Burners +NO. of Emergency Lighting
IBattery Units
No. of Switch outlets NO, of Cas Burners
FIFE ALARMS No. of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals No. of Heat Total Total
Pumas Tons No. of Sounding Devices
No. of Dishwashers Space/Area Heating INo. of Self Contained
Detection/Sounding Devices
No. of Dryers LHeat�:LngDle�vices KW I Local('� Municipalu ConnectionLJOther
No. of Water Heaters KW O1 10• °LLow Voltage
s Ballasts WIrin2
u
No. Hydro Massage Tubs No. of Motors Total HP
OI�R P',C IV- D'"l� oLv e G >�G cam, t r ( /2 v. t`S• � �"/Z o N �f
L
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current LiPL"tT Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES U NO 0 I have submitted valid proof of sale to this office. YES 0___SIO
If you havrBOND
ked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ OMR❑ (Please Specify)
Estimated Value of Electrical Work S /r1� 600 tp=Elon Later
Work to Start /,0 /[1 ^a Q Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME ,C-=� �� � C 6c) " LIC. H0. A)
,3b
Licensee [s_S / Sigaatur LIC. NO�E)
to
Address 5 Zi W B 1. No. /--�
OWNER'S INSURANCE WAIVER: Alt. Tel.
I am aware that the Licensee does not have the insurance coverage or its suo-
stantial equivalent as required by hassaehusetts General-=WT and—'that v7 signature on this
application waives this requirement. Owner it
Agent (Please check one
Permit Fee�T/SCSoy(a
Telephone No. Receipt
(Signature of Owner or Agent)