HomeMy WebLinkAboutWiring Permit - Correspondence - 1116 GREAT POND ROAD 1/21/2014 Date.... ..�.. .i
p10RT�y
• °g TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
CHUg�
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This certifies that .
............................
has permission to perform /)C ....
wiring in the building of .1
at
North Andover,Mass.
Fee .. .................Lic.No �... ..�
..... ...........
Check# LI ELECTRICAL INSPECTOR
��� UL-5
0—fal
BOARD OF FIRE PREVENTION REQU IONS
lease a yip cacles&e[e_C&dafj'S
[Aev.11071 �Ieaaya blaulk)
confrad ffi&h1d P—ennU M if a Ifea
A j I
PPLICATION FOR PERMUTO PERFORM ELECTRICAL WORK
m work to be pm.'LoxmDd in accordance with the Massachusetts Electrical Code QkfflQ,527 CAM, 12.00
(TEFAYE_PMff_WflVK OR TYPEAL&WFOBAMITOW) IWO:
CRY OrToYmof: 46,v-1 # /)VLD L' To the 1wector,of Wh"63:
By this application the rmderslgaeA gives notice of his or her infradoa to perform the eleottical work dcsm!bE-;dbOlow,
-7
Location(Street&;Number)
9.7,P Owner orTena#; -
1�1
n this permit,is conjunction with a building permit? (Check Approplia-te*Box)
Paxpose of Building
Utility Antlzorizrafion No.
P"�d'5�g Service Amps / Volts Overhead U - Tindgrd-[_1 .No,of Mete-rs
New-Se-1—.vice Amps. / \"701tg Overhead Uudgrd Q No,-of Mterg
-----------
Lo caff on.and Nature of proposed Ele'Q tdcal Work: UIS 1cill /�16 It j
Co letiort f the fol1w table may he-v),*edby the Inspector of Wines.
IN aof 'Total-
No.of Lamirtalre Outlefg N.G.of Hot Tubs txenerators ETA
—Above In- M 0,o me):9611CYLVAtug
NO.Gffmminaircg swimmingpool Lj
Gaffe ry Units
No.Of Switches Not of-Gag Burners No,OfDetection and
Tot
No,of Ranges No..of Air Cond, Tonsal Na.of AlartingDeyices
Heat'pt' Tons IOW IND.of Self-co, ined
To= Number
No.of Waste.Disposers Defection/Ale U -Peylca3
' Municipal
No.of Dishwashers 8PaceMxeaHeat1n,-XW r1oca10 Connection 0 offie,
Security Systems:*
No.of Dryers Heating Appliances KW No.ofJ)eY1cworEqu alent
No.of Water No.of No,Of Data Wiring:
Heaters Signs Ballasts No,of Devices or Rq utvalent
Telecommunicattons'Wixing-
!LTo�Rydro ra asg age Bathtubs ING.of Motors TOW HP No.of Devices or Rq
11�C'1111111_12
OTHER:
(WIenrequiced by municipal policy.)
Estimated Vguo offfleaftical Wo&'�a212
WOrkt'D Start: Inspections tobaifquestrz;divaccor&,-lc4-,withAIBC Rile!O,and upon coilipletioD-
jNsLT_AffcE COVE GE: Unless waived by the,owner,no permit:for the p6iforin2ace.of electTical work may issue, ss
the licensee provides proof of liabiliV iusuraam including."coropIded operation"coverage or its Substantial r IV a
qLE alent, Th
undersigned ce> tes the;such coverage is in force,
and has exhibited proof of spmD to the permit issuln,-office.
CHECK ONTF_ INSUBAINCE U BOND ❑ OTFER X. (Spbcil�-) Self Insured
SUMWAM. ADTLLCDBkA1)TSwor[W LIC-NO.: C-172
Licensee: Thomas 11,00 igna, re. Me-UO.: C-172
(2fopplf-a6k.P_ r qxeinof, Bus.TeL No.,
e I No
Address; 0, Alta Te, -:(a08
'Secu
rity System ConfractorLiceuso required fox this work;if applicable,eater the licensonamberhua: 001779
does not have-the liability insurance coveragpp noYh:LaHY
'are that the Licensee a
TIUNCE WAM - I am.aware _j
MMR!S W81J
requhod by law, By my signature below,1-h=by waive,this ruluirommt. I amtho(check one)0 owner _E1 owner's agent
OwAbr/Agent
FP
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Of P,I�(Iwa
lot
OvIvIv.masis'agoylefia
A
AER'SecurityServices
Addresa,— 180 Clinton Drive
ip y
�FLqllis P H 03049 Ph 6-03-59 -5 o-T)e.
Are ymulu e-MvTOY'qr?c-beg"',OP.up Propriate Ws", type vTrjFORmt(qrequhrm]).
I i1aT-inj.Lemiwt 1 Q0+ 4, j:T am
_ I'Paead 0,11"dioaffadhoa ew%. 74 RemodOlqg,
llmesdh-confyawny-,hava
ob!and DI'ma"m 90yeen
vvfjrkioa ..far mete my tx�paaiily' addidon
Ired aro a corpora-flo',Ord iN 13 v WEI'Mucir I cA'
em UIRmy;same camod the 11.D of Wak F#9l
1 U3 1 mw a jloruuer d ILng A worl, i
TrIght aoxemptiou Per MOL
UDW[No vvz'OrAkmere corsly. I zo Roof-cep'llm
c,j52,§IjIV and sm 11WO 110
1.3,90 WLow Volt
clakplovem[No m&"ersil 0-cmp�higuranco reg4red.) Security SVstem i
Any ft p pI i d2m t D Inat A ltdl*bu.X A M13 5 f Av,r,11..5 at the N b d1i rIn be I 6wsb uik hi g th 4 in4 orker.'comn p.rm s m 1 o n.rm I 1'e-v fn fb rftiv RI
T-Tc,w owt e Ps.who,,nkmi t Ah�TI 41'ft I Md3'0 D E 110P,'OOY 11ft JO I nig al I wFj rT,ihuti th e a 14m o u%-E4 P,co.1 tracm rb-a m�,,-t 2,u b m it a rttvp riffidw[t&WA-m I In gg 5 u ah
Ic rp h 1.1-a cro I R that c ft CN,.R Ih i-5 wx ta i is r AlDxhc d ph n M i 11'0 ff;AA c4ca d 0%,iti'v th a III-m 0 of 13b o gu bv co ntm V d n aMVuTI7 wII Q-fkcf 0 F a Ot 1110 0 WR 199 11 AvI,
cli&y4w-s-
Zurich American Insurance Co.
WC509589701MC509589801 .xpjr,jroll T 10101/2014
j
Rib Site Address: WN �Ai� 0\�
AMach ator deeI Am 000 Pagp jkowing OF,porwy mu f Ahar and cmpfnd km dal�).
_V compemairmaup
WHO ta smarne.cowrage nmjuired oudew S�,�,tl on 25A of.MG L C.152 can.lead to th a UPOOlon(.-)f Criaffnal'pcmaldc P,'01"a
`me"up to,$1�500A-aftwo r one hvipd� fl.m
I �yvad mmuorit gs M as form uN UrOP WORK ORDER and.e M
'f lip to$2,50.00-a. day agallb-sa the!vlWatm DO adv.lsed fl"a�-a-copy of th-i's ilatcarient m,ny be,fonvarde-d-,to Aho,Offi-ca 01"
1010 MW call OMM MaPM qtpc�jwy thal Ate sefffemdeorrom
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603-594-5_ .......
............
Qffllmlfffsvwfi r. Boll Izolml(a en this area,to 6R e0rupfuledby CIOP mrawittiffi'vAuL
'My'or Town:
ImIng Aufbona((ehrelp oua)'z
A Bond vrhau I M-11 1300 l3lig"aw fr9m m It Clerk. 4.,TIMM riva I Fmqr4 equ 5,