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Home My WebLink About- Correspondence - 43 HIGH STREET 9/29/2012 Date ......... TOWN OR NORTH ANDOVE:IR PERMIT PO R ,•.. . WI N 14U z � This certifies that c ` has pernussion to ..................... rfo ......, Pe rin -�� .... wiring in building ilding of ......................... b at t n ^ �..� k�................ f North An 1...... F r ...� No lover M r ee .. Lic No C �� A. s Check# ELxcmc,�,G..... ' I , Uo6rA'BBPm9Ewealth o ffassac 71useds Official Use Only Department® ®Ve Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS (El-Cass adoi'z 2 codes 8, electP®cian"S cell ' Occupancy and Fee Checked [Rev. 1/07] cOnt6ract it&,�Id a��Bd➢9® Blr sd3�3B%��f�^) (leave blank) APPLIC/A TD M FOR pCR�la it TO PERFORM C LEOT=AL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C 12.00 (PLEA E PRINT.IN.INK OR TYPE ALL INFORMATION) Date. 7 / 7 City®r Town® ° d ?'K To the Inspector of Wires.- BY this application the undersigned gives notice of his or hei•intention to perform the electrical work described below. Location(,Street&Number) Own er o r Tenaut ?•' Telephone No, Owner's Address Is this permit in conjunction with a building permit? Wes ❑ No (Check Appropriate Box) -Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New w Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters 'I�Tesiaz�efl;of'l`eeciers and Arazpacify- .; Location and Nature of Proposed EIectrical Work: `�� `ea i o ) z. '�' C1! � �c S i erv� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Tans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators HVA No.of Luminaires Swimming Pool Above ❑ In- o..o mergency rg r ag rnd. Md. ❑ Batter Units _ No, of Receptacle Outlets No.of Oil Burners IIREi ALARMS No,of Zones No. of Switches No. of Gas Burners No.of Detection and — Initiating Devices ,. No. of Ranges No, of Air Cond. onsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons W. No.of Self-Contained Totals: Detection/AIertino,Devices No. of Dishwashers Space/Area Heating IOW Local❑ Municipal ❑ Other ' Connection No. of Dryers Heating Appliances IOW Security Systems: / No. of Water No.of Devices orEquivalent No. of No, of Heaters � Data Waring: Signs Ballasts No.of-Devices or Equivalent No.Hydromassage Bathtubs No,of Motors Total SAP Telecommunications Wiring: No.of Devices or Equivalent OTTIER: i i Attach additional detail if desired, or as required by the Inspector of 9"fires, Estimated Value o Electrical Work: �y9.p y (When required by municipal policy.) Work to Start:tAwInspections to be requested in accordance with MEC Rule 10,and upon completion. 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: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured !, .certify,under the paints and penalties ofperjury,that the irzfo..rrtzatioxt oil this application is true and comp ' lete. ]FIRM NAME: ADT LLC DBA ADT Security 1`` z LIC.NO.: C 172 Licensee: Thomas J.Leeignature applicably.e ,'` f � i LIC.NO. C-172 (If nter^ "esernpt"in the 11 ense murzber line,) �,, Address: G �f Bus.Tel.No.:�n t?� �c��S�J�`� �\ �:o CC�tr1't e '+ r , \his, r�1�' C��r34,r� Alt.Tel.No.:__ r. Security System COMxde.tor License required fox this work;if applicable,-enter the license number here: 001779 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner Owner/Agent ❑Owner's agent. 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