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No 2438 Date ... ;�
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that'....
has permission to perform ....... Lf .....
wiring in the building of ................................
.. .................................
at.c9"...22� ....... !� ............................. . North Andover, Mass.
Fee :X:� .............. Lic. No.:..........................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
t4soo
The Commonwealth of Massachusetts Office Use Only
Permit No.Department of Public Safety
Occupancy & Fee Checked �"
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/92 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
Date LZ -_06%
Town of e, MA. /U Awo✓&P2
To the Inspecto0of Wires:
The undersigned applies for a permit to perform the electrical work described below.
oe) Mass Ave
Location (Street & Number) aa
No. of Hot Tubs
Owner or Tenant - - /y/ 4,010AJ /'H LAW al AA
No. of Transformers KVA
Owner's Address 6AMi5n-
of Lighting Fixtures
Is this permit In conjunction with a building permit: YES ❑ NO *-,C- heck Appropriate Box) Building Permit No.
Purpose of Buillding ?OlpeAlcf- Utility Authorization
No. - oosq
Existing Service 100 Amps_/ 240 Volts
Overhead
Underground ❑ No. of Meters LI
New Service -fQ0 Amps -1-20/ Zq O Volts
Overhead
H r
Underground ❑ No. of Meters
Number of Feeders and Ampocity 3 Al-um5
Location and Nature of Pro osed Electrical Work RZ a41,c- ®%i®
5-KoAlIC-15 a" 3�*,06760 y eoAf
_AAS )14lFAB! STA<< /(JeAJ dQO® ii PX# /
11FiO P oLn-t;foP
OTHER: :EZ, f*c /j&_,e,P Czz c-aA s'yMP pill -9
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability
Insurance Policy inclluding Completed Operations Coverage or its substantial equivalent.
I have submitted valid proof of some to this office.
If you have chpftd YES, please indicate the type of coverage by checking the appropriate box.
INSURANCEJU BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ %00
YES0 ElYES NO ❑
( xpiration Date)
Work to Start vL 2� Inspection Date Requested: Rough Final W/LZ CAI
Signed under the pen I,t�je of ori ry:
FIRM NAME ��� ``_TI��Q A Ar LIC. NO.
Licensee g "04 Signature LIC. N0074�3ZyL�
[/ A� Bus. Tel. No. � 6�
Address �7/ / "/�����?� /�l Alt. Tel. No. 516 37.'1
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as
required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Plear� one)
Telephone No. PERMIT FEE $ L��%/
(Signature of Owner or Agent)
r
Total
No. of Lighting Outlets _
No. of Hot Tubs
No. of Transformers KVA
No.
of Lighting Fixtures
Above
Swimming Pool ground
In -
❑ ground ❑
Generators KVA
No.
44No.
-of Receptacle Outlets l 4P )00,1/'No.
vul
of Oil Burners
of Emergency Lighting
Units
_Battery
FIRE ALARMS No. of Zones
No.
of Switch Outlets
No. of Gas Burners
No. of Detection and
Total
No.
of Ranges _
No. of Air Conditioners
Tons
Initiating Devices
No. of Sounding Devices
_
Total Total
No.
of Disposals
No. of Heat Pumps
Tons KW_
No. of Self Contained
__ _
No.
If Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
Municipal
Local ❑ Connection ❑ Other
No. of Dryers _
_ _
Heating Devices KW
No. of
No. of
Low Voltage
No.
of Water Heaters KW
Signs
Wiring
-Ballasts
No.
Hydro Massage Tubs
No. of Motors
Total HP
OTHER: :EZ, f*c /j&_,e,P Czz c-aA s'yMP pill -9
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability
Insurance Policy inclluding Completed Operations Coverage or its substantial equivalent.
I have submitted valid proof of some to this office.
If you have chpftd YES, please indicate the type of coverage by checking the appropriate box.
INSURANCEJU BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Electrical Work $ %00
YES0 ElYES NO ❑
( xpiration Date)
Work to Start vL 2� Inspection Date Requested: Rough Final W/LZ CAI
Signed under the pen I,t�je of ori ry:
FIRM NAME ��� ``_TI��Q A Ar LIC. NO.
Licensee g "04 Signature LIC. N0074�3ZyL�
[/ A� Bus. Tel. No. � 6�
Address �7/ / "/�����?� /�l Alt. Tel. No. 516 37.'1
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as
required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Plear� one)
Telephone No. PERMIT FEE $ L��%/
(Signature of Owner or Agent)
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