HomeMy WebLinkAboutMiscellaneous - 465 GREAT POND ROAD 4/30/2018 1465 GRF-4 POND ROAD
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10/064.0-0029-0000.0
N2 2 ,-) 90 Date.......................
TOWN OF NORTH ANDOVER
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A PERMIT FOR WIRING
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Thiscertifies that'.- ............................................ ..........................................
has permission to perform ............................
wiring in the buildingbf. 2,..... '�!...... ..................................
at.. ....... North Andover,Mass.
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// 'ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. OINK:Treasurer
90
The Commonwealth of Massachusetts Office Use Onl
Department of Public Safety Permit#
Board of Fire Prevention Regulations 527 CMR 12:0 Occupancy&Fee Checked l>�
390 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with Massachusetts Electrical Code,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date March 9, 1999
City or Town of No.Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street&Number) 465 Great Pond Road
Owner or Tenant Marie Laughlin
Owner's Address Same
Is this permit in conjunction with a building permit: Yes a No F-X (Check Appropriate Box)
Purpose of Building Utility Authorization No. 90/5b/
Existing Service 100 Amps 120/240 Volts Overhead Fx-]Undgrd =No.of Meters One
Y
New Service 200 Amps 120/240 Volts Overhead F—x--]Undgrd =No.of Meters One
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Replace service due to fallen tree
No.of Lighting Outlets No.of Hot Tubs No.of Transformers
No.of Lighting Fixtures Swimming Pool Generators
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switches No.of Gas Burners FIRE ALARMS
No.of Ranges No.of Air Cond. Tons No.of Detection
s No.of Disposals No.of Heat Pumps kw No.of Sounding
No.of Dishwashers Space/Area Heating kw No.of Self Contained
No.of Dryers Heating Devices kw Local
No.of Water Heaters No.of Signs Municipal
No.of Hydro Massage Tubs No.of Motors Low Voltage Wiring
Other:
INSURANCE COVERAGE: Pursuant to requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent YES r 7X NO [7 I have submitted valid proof of the same to this office YES NO L___.1
If you have checked YES,please indicate the type of coverage by checking the appropriate box.
INSURANCE M BOND L7 OTHER [7 (please specify) 2/2/00
Estimated Value of Electrical Work (Expiration Date)
Work to Start Inspection Date Requested: Rough Upon Request
Signed under penalties of perjury: Final Upon Request
FIRM NAME Dumais Electric LIC.NO. 12170A
Licensee Mark A.Dumais Signature LIC.NO. 26665E
Address 8 Newport Street Bus.Tel.No. 978-683-9438
Methuen,MA 01844 Alt.Tel No. 978-685-4553
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or it's
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)