HomeMy WebLinkAboutWire Permit - Permits #12171 - 176 CARTER FIELD ROAD 2/18/2014 \17-101, c\
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Commonmealth of fwass�achff'seu-'6 officlal Mo Only
BOARD OF FIRE PREVENTION REGULATIONS
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APPLICATION FOR PERM I- TO PERFORM ELEG-MICAL WORK
All Mork to bap roamed ia axordanre with tha MassabTiust1f3ETcctdc4 Code 02 EQ,527 CMR 12.00
(Pm'MEP=M-&7C OR nTE"ML.WF'O.WIMWVON) Date,
City or Taw-,u of 110 the Inspector of Wires:
-By ffih�applioatiov,the andanigaed-g�yeg i2odca WEE orhar 11too to e)
ycaflon(Street&NUMbel:
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Owner or Tano-A Telep n5M)�Owner's Address
f3 this permit is conjunction wn a buffffigperoaft? Yes (Check Approprhfe Box)
P-axpose Of Enadbig
Utility ATAftorization No.
Amps f ---Volt- Overhead EJ - Uadgrd[J. No,of Meters h*
Ee!Serdca Amps. / -Volts Gverhpad El. Undgrd El No,of metrg
t'um or of16f—�Rirs
T-oaatfoxL and Nature otFtoposed2lectrical Work.
C077W[egOn afihe jollrnvin table may kewafkdbythe Inspector of�jrzs_
o tal-
-0 f-R=as g,ad-L a Min a h;es—
No.offmnivafra 0-affAq No.of Hot Tubs Genekatarg KVA
fa-
:,DOI 4 mint k -g&UV
No.of Tnmtnaire3 Swim -0 T-4,
-R.04—TM a
No,of-Ranges No..of Air ConcL Tong No.of AlDrtLag Devices
Flo.of 01witches No.of Gas Formers No,of"DeLectioll and
No-of WasteDisposer Heatllna IND.of Self amber Tons ed
TO DetcCL'don/A' 1'erff:o
No.of Dishwashers Space/AreaReating KW Local El q omeTal
ar
No.of DiTers HeatingAppBanceg Kw—Swuritysy- Ms-.*
No<of water-- INO.of No.of ATO.o0evicea or Lnt
D2 fa Wiring:
Heaters Ballasts
No,of D�e-ylces or qnivalen L .
NO-Erydromassage Bathtubs No.of motors TotalTTP 'ons'Wixing:
Na,ofl7evices or
uxYalent
Of
(When req,-ir,1 by muoicipall policy.)
Work to StRlt— Inspections to be xeqmsted,iaaccordauca withldEC R-ale 10,and upon coq?J5,dom
INSUIZANCE 60VERAGE: Unless walyed by the owner,no perrnit flor the per,Lormtnce of eleGtdral work may issue imless
the licensee provides proof of liabiEfy fils- d
or its Bnb&�,'al PqLdvakro-, The.
rinderigned cex�tes i-ba;such.cayerage rs in farce,and has e:�hz'bited proof of sa-�n e to t1�e parvzii issuing of�Si ce. � '"
CIECKOINE, INSDRAINCE El BOND EJ 0=1 i (4pcff' ) SpLfaured
XcettPJ�,Wider fhepOls Lwdpa,'14W of perpry,thaY the-r'f%f'�ar-wfnitau On thiv qF'PzkadUU.is i�ad a7rd comTleta
NAM,ADT LLe Di3A ADJ'Swarity LIC NO- C-172
Y 1cengee. Thomas J Lea C
#1 P
LT .U' 0,: C-172
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Bog-Tel.No.-
Address, /,,/1-ej, 1Y 0, �9
Alt Tel Ro.:0-09-3w— 'E�Cl IZ6
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Srenri�SSystemCozdzactorl,icenso required for this wOrlt;if applicabta,Ou L t C' 001779
OWNER'S INSID3 1 'EWATNER: Imn arc fiat he LIcemeo does not hove the Habil-Hy in-,omm-n covelaganol-Inally
3ANC
ro quit ed by lay,,, lay any s ign abza below,1hembY waive this I:rqn LOM M I arm-[No(ohe-bk one)❑own ev Owner's agent:
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OwAar/Agent
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W-1 ADT Security Services
Clinton Drive
Clty/ftt,&,W'p� Hollis NH 03049
Are ymgMaui empaqw?c. t0k-Awapprop r1h4f P b y
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ship mgi fi�i ena anpiqew,, C7u a sub-confractors.,havo
NVOTInog An,The.fil any aqp'wj'j4'A
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required'] Wectrkai xoparrs av q-4,111tJOLIA I*aro 3-corpo ration-und Ww
3-El 1 aw a hogruenver(Inig W'.'OyJ4" ol',iffixer's Davo exrru-is-W their
'd-ght of oxemption pot MUL 1 22, Roo frepairs
and we have g o
Low Vol
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SqLurity.
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COMIlmnsaelign insurpnegfir my tomployees, '9810 w�s alapalky andjob rhVe
b.-wranca C-cm, �ifiy Xamv,,, Zurich American Insurance Co.
gy, WC509589701MC509589801
10/0 1/2014
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vn#Vr.Sk.�o'ffcn 25Aaff INGL c.152 can Kadtfutha f cSsMon of
Olho up to$1�5000- flip,Va.rin of a UPC WORK ORDER Linda flne
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