HomeMy WebLinkAboutWiring Permit - Building Permit - 45 GLENWOOD STREET 12/2/2013 (3) f
...........................
TO
WN OF NORTH ANDOVER
PERMIT FOR WIRING I.
B�CHUB�
I
This certifies that ��
has permission ...
to perform �
wiring in the bull ding of
at � n , ........ ........................ •�,
'Lee
........................... No Andover,
Fee `,. ...............Lic.No: .................... Mass.
.4f�Check# g ELECTRICAL INSPECTOR i F
(f.mmonwea&of Maijac4aiethi Official Use Only
Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C), 27 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL FORMATION) Date:
City or Town of:,LIX,114�e To the Inspeitor of Wires:
By this application the undersigned gives notice of his oilier intention to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant 1_,�d7 "21 Telephone No.2zg,,k/e-A;23/
Owner's Address
Is this permit in conjunction wi h a;)building permit? Yes ❑ No El (Check Appropriate Box)
Purpose of Building e-, Utility Authorization No.
Existing Service Amps Volts Ove r"head ❑ Undgrd❑ No.of Meters
New Service Amps Volts OverheadF] Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Coniplotion of thefiollowing table may be waived by the Inspector of TVires,
No.of
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Trans Total formers 1kVA
No.of Luminaire Outlets No.of Hot Tubs Generators I(VA
Above Ei lit- —,No- ot Emergency Lighting
No.of Luminaires Swimming Pool gi-nd. gi-nd. El Battery Units
No.of Receptacle"'Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
of Detection and
No.of Switches No.,of Gas Burners No. Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Tons..Ps .. I<W No.of Self-Contained
Heat Pump I.Nu.m.b.ei.... ...... . .. .
'No.of Waste Disposers Totals: I I....................... Detection/Aler ting Devices
No.of Dishwashers Space/Area Heating KW LocalE:1 Municipal F Other
Connection
No.of Dryers Heating Appliances 11CW Security Systems:*No.of Devices or Equivalent 45,No.of Water No.of No.of
K'W Data Wiring:
Heaters
Signs BallastsNo.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,or as required by the-Inspector of fflires.
Estimated Value of Electrical Worl_14�0-11�/*,/ (When required by municipal policy.)
Work to Start: KS,j\--V _Inspections to be requested in accordance with NMC Rule 10,and upon completion. eo),
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; INSU12ANC13 El BOND El OTHER k (S`pecifr) SffIf h=ed
X c I ffii&appikadua is true a7id con,plete�ff 10,wider thepaLv azidpeimWa of pe&,ry,that
MVNAM. ADTLLCDBAADTSwarity L1C_N0,: C-172
Licensee: Thomas 1,Lea ignatare 1 C.UO_- C-172
(IfappXzcable.Pn&l mu 2714411-11, Bus.Tel,Xo.,
Address; /X. h- 1,0 Alt-,Te-1
Sr urAy System CoutractorLicfPsDrcqojxod fox this work;if applicable,enter the license number lirm: 001779
U the liability imtirance c a Y
OWNEWS INSL�Aff CE WAMR. I mi a:�YaxD Via*the Licensee,does not have ov rage uo Inally
required by lave, By my sigaatara below,I'h=by waive this ruj*ommt I amtho(6hb-,k one)F1 owner Elowna'sagant
GwAar/Agent-
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