HomeMy WebLinkAboutWiring Permit - Permits #11792 - 39 FLAGSHIP DRIVE 8/15/2013 Date...' : ......
NORTH
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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This certifies that ....... : .F.... "�
has permission to perform ................ ....::. ........".....:...........................
wiring in the building of....... ......................... ...........
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at .North Andover,Mass.
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Fee.... ......a................Lic.No. .. . ................... ... .. ..
EL CAL INSPEOMR
Check#
Commonweafth offyas6achusafts official Use Only
Department of Services N-Tinft NO. 1 17�21
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APPU CATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to bap formed in accordance with the Massa0fiusf-,ttsElouWcal Code WQ,527 CNM 12.00
(TLEAYE PBINTI Y)NK OR TYPE A61, NFOMA YI-010 Date:
City or Town of. Aln Ae-le;4� IV
-Vo the Inspector of Wires:
By this application the undersigned gives notice ofbis or her intention.to perforin the aleoftical work described below.
Location(street&It9ber)
Owner or Tenaut 41 to
7-ee 6k&
Owner's Address
Is this permit!a conjunction veith a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / volts Overhead[] Undud-0. —No.-meters
Neyv Se-1--dee Amps. / volts Overhead EJ UndgrdE] No.of Materg
Tqumber oYk-.edrs and Ampi,-�i—fty —
—
Location and Nature of Proposed Electrical Work:
CoWledon of thefolloW table may be waived by the Infector of Wires.
Iff').ofa-os Total-
Va-of-Rmess6d-Lumln
No.of Luminalre Outlets No.of Hot Tubs Genekators SETA
Above F1 fu- M cy)-ighbug
No.of Luminaires
0 0--of f R L L'
N'DFaf-Gil-B -ML-r-S
N6.of
No.of Detection and
N6.of Switches INO'of Gas Burners
I Initiating Devices
Total Na.of AlerfingDeyiees
No,of Ranges No-of Air ConcL Tons I
N" of W, Heat, Tons JKW No.of Self-Contained
o.of Waste Disposers. a IDetection/Ale rda-crDey1ces
No.of Dishwashers c'
Space�Area Heating k-W 1:10 ca I E!c un'
Dail
No.of Dryers Heating Appliances KW Security Systems-,*
No.off)evices or Equivalent
No.of Water Of No.of
KW Data Wiring:
Heaters Signs Ballasts No,of Devices or Equivalent
No.RydromasgageBathtuh.9 I-No.of Motors Total BT Telecommunications Wiring:
No.ofDevicesorl?quivaleut
OTHER:
E!�h aMtibnal detail Ydesired,or as required bythe Inspector of P7ires,.
'4
Estimate-dValim-ofaaGtricalWQrk-. 6,-61 (When required by municipal policy-)
Work to S1 A-P Inspection.-to be requested fii accordance with N=Rule 10,and upon complation-
INSLaZANCF,COVERAGE. Unless waived by the owner,no pereiit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its subgtarLtialcquivalenjL The
undersigned cerUos ihat such coverage is in force,and has exhibited proof of sAmG to the permit issuing office.
CHECK ONE- INSUBAINCE 0 BOND El o=x (Specify:) Self h=ed
under thapabu and penalties ofper I this appReadou is Zrae and complete,/ury,tied nee�n1a=aVoAon
YMM NAM: ADT ELC DBA ADT Security LIC.NO.., C-172
Licensee-. Thomas J.Lea igua, e LIC.WO.: C-172
(Yf appikahl'. -the lime numb Bus.Tel.No.:
Address-, -0, 0'v Alt TeL Xo-:008
'Serui-ity System Cont-actorLicarsD required for 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 coveragDnol�ally
requirf,-d by law. By my signature below,1-hereby waive this requiremont I amtho(check one)El owner El owner's agent
owncr/Agent
Signature