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J 210/098.C-0079-0000.0 1
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TOWN OF NORTH ANDOVER
Building Department
1600 Osgood Street `"°_ �-�• M
Building 2- Suite 2-36 Building Dept 9ssgc►+us�ti
North Andover MA 01845
Tel: (978)688-9545 Fax(978) 688-9542
COMPLAINT FOR INVESTIGATION
DATE: -Z— 2o� TEL#:
NAME OF COMPLAINTANT: t_h° k t r—,
ADDRESS: 53 C� S�►��
COMPLAINT TYPE:
Electrical:
Plumbing:
Gas:
uildin n :►�� e v -� o
Property Owner: C' l � _t;�AiNYI- 69W2 - 31c)
Address: Z ` X1(2 R`-1 ILL Lf�',,tJL
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Signed:
Complaint Porn-Revised 6.2007
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Date ...Q3..........
NORT►,
°`, ``° :•�"� TOWN OF NORTH ANDOVER
0 PERMIT FOR WIRING
SS S
This certifies that ...... ..............................................................
has permission to perform ...:r.. ..........:. :,: !: ..........................................
wiring in the building of'....`.*' ................................................
at...�.... ........................... . ....... ................. .North Andover,Mass.
16 °"y......... Lic.No.A .,%'�°,- j � �.... ...
Fee ........... ..................................
�ELSCTRICAL INSPECTOR
Check #
4747
` Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. 4-7
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 CMR 1 .00
(PLEASE PRINT IN INK OR TYPEALL INFO 2MATION) Date: o
City or Town of: To the Inspect r ofWires:
By this application the undersigned give n tice of his or her inte t ton to erfo the electrical work described below.
Location(Street& umber)
Owner or TenantZJYT
lephone N(
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Security system
Completion of the followin table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool rnd.Above ❑ In- o.o Emergency Lighting
rnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
o Detection an
No.of Switches No.of Gas Burners No. Initiating Devices
Total
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers . Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent Ge
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.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 Wires.
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 ❑ (Specify:)
(Expiration Date)
Estimated Value of E ectrica Work: — (When required by municipal policy.)
Work to Start: ? ��/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
1533(l
Licensee: John S. Bassett Signature LIC.NO.: 1533C
(If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 603 594 92$
Address: Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Li see 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's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ '