HomeMy WebLinkAboutMiscellaneous - 1408 GREAT POND ROAD 4/30/2018 1408 GREAT POND ROAD
210/060000.0 \`
Date....
�.............G / ...�N°
f NORTF�,
�?;•�:�``°;•�"�,� TOWN OF NORTH ANDOVER
� p
PERMIT FOR WIRING
,SSAGMUSE� `
This certifies that ..:... .:"-''' ,
............................................................................
has permission to perform
............................................................. . i
wiringin the building of........................ ..........................................................
L s s
.... .. ................ .North Andover,Mass.
Fee....................... Lic.No.. '" 'S
3 ELECTRICAL INSPECTOR
09/04/98 10:12 50.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
Office Use Only
Permit No-
1.19
�4
?�� e0'ni�lld".lZ�/£�.c'?"���llr;zSSr�ertrllSc`'775 Occupancy&Fee Checked
UV
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ali work to be performed in accordance with the Massachusetts E!ectncal Code 5;73R
9
12: 0
(Please Print in ink or type all information) Date
To the Inectorlof Wires:
Town of North Andover
The undersigned applies for a permit to perform the eelectricaleelectricalwork described below.
Location(Street&Numbe''rr0 d G'lqc crl t OUo &0"
n /to
Owner or Tenant ( goo l'�-S sc17'06
Owners Address S~E
Is this permit in conjunction with a building permit Yes a,,-" No ❑ (Check Appropriate Box)
Purpose of Building_ Utility Authorization No.
Existing Service �n Amps Volts Overhead ❑` / Undgmd ❑ No.of Meters
New Service Amps 2` lJ 2U Volts Overhead (Y Undgmd ❑ No.of Meters
Number of Feeders and Ampacity Y�
Location and Nature of Proposed E!ectncal Work W l� 16)0~ S&-' w c F-0 00, r`J e—w -
Total
No.of Lightting Outlets No.of Hot fuse No.of Transformers KVA
Above ❑ In ❑
No.of Lighting Fixtures Swimminq Pool gmd ❑ gmd ❑ Generators KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Burners Battery Units
N
of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone
Total No.of Detection and
No of Ran es No of Air Cond Tons Initiating Devices
Heat Total Total
No.of Diposal No. Pumos Tons KW No.of Sounding Devices
Nod of Self Contained
No.of Dishwashers Soace/Area Healing KW DetectiorvSounding Devices
❑ Municipal ❑ Other
No.of Dryers Hearing Devices KW Local Connection
Nd,of No.of Low Voltage
No.of Water Heaters KW Si ns Bailases Winn
No.Hvdro Massage Tuds No.of Motors Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Uability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO =
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 = BOND = OTHER = (Please Specify)
p (f� (Expiration Date)
Estimated Value of Electrical Work4 0 s Q Q J2
Work to Start
¢�Jt�ry, Inspection Date Resquested Rough Final 6
tle
FIRM NAME Signed underthe V t V�CJ7t/t�1 L �l C- LIC.NO.
14
rucensee -JC) C',;T02�C— Signature UC.NO.�= 4�0 C-!;
Address
LC-�UGtJ09L/ A6 eyogew 44eat eel rNia. 7a '
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
I
