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S
Date ..... .0.�..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..........e� ....... :.:........
�1 ..........��/t. rP..... �'
has to perform �n <l�
................. ....................................................
wiring in the building of .........� 0 /............. / S
`.1l ......................................................
at ..........................................................
..... ,,North Andover,
Fee ...fit �....f?.. Lic. No .............. ...............,� ..................
Check #
7V CAL INS ECTOR
Commonwealth of Massachusetts
(�rrciul u.� o,�ry
Department of Fire Services
Permptu,
No
BOARD OF FIRE PREVENTION REGULATIONS Occunc
y <and I-, ce Cltec,ced
R
APPLICATION FOR PERMIT TO eV 99, t(!:,vcblank) _--
A[I wuik to t><perti,r,ned in accordance wilh the MasPcERtFtOReM� ELECTRICAL WORK
(LEAS£ I'lUAIT IN INK OR TYPE ALL INFORMATION) )' 327 C N41Z 12.0a
City or Date: Town of:
By this application the undersigned gives notice o his or her intetentiLt to pe torTo lhe m the electr!t)r u/ Wlre,�:
Location (Street & Number) �> ) Xn Ne,,, __ , , teal work described below.
Owncr or Tenant
O%vncr's Address
ZMEM
Is this permit in conjunction with a building permit? yes
Purpose of Building ❑ No
Existing Service Alnps [ Utility
Vults Overhead 11New Service Amos .� ver.,,�� • f1
oI " ��d
Number of Feeders and Autpacity ;,
Location aiid Nature of Proposed Electrical Work:
No. of Recessed Fixtures
No. of Lighting Outlets
No. of Lighting Fixtures
No. of Receptacle Outlets
NO. of Switches
No. of R�ogcs
No. of Waste Disposers
No. of D shivasliers
No. of Dryers
No. of Water
Heaters
'I•elephone No
-3934_ -
W (Check Appropriate Box)
.uthorizatiort No.
Undgrd ❑ No, of Meters
Undgrd U No. or Meters
Completion o 'tire nllowinY ruble Ma�y be waived by the lrupector Of wires.
No. of Ceil.-Susp. (Paddle) Fans t 0.0 otal
ITransforrtters KVA
No. of Hot Tubs IGcnerators I(VA
Swimming Pool o (1 n- o. o tncrgency tgtrUng
end. ❑ �rnd ❑ (Battery Units
No. of Oil Burners
No. of Gas Burners
No. of Air Cond. Dotal
Tons
cat utttp um Der Forts
Totals: — --- --......... ...
Space/Area Heating KW
Heating Appliances KW
KW U0 lo. of
Signs Ballasts
No. Hydromassage Bathtubs _ INo. of Motors Total HP
OTHER:
FIRE ALARMS No. of Zones
1 o. o Dctcction and
[nitiatin Dcviccs
;No. of Alerting Devices
No. o Se f- ontaiucd
Dctection[AlertinDevice
Local unictpa
COnttectl0rt Other
ecurtty 'ystcrus:
No. of Devices or Equivalent
Data Wiring:
No. of Devices or E uivalent
I elecomtnunicntions rrtng:
No. of Devices or >: auiv_r, ; #
Attach additional detail ;J dcs,red. or as required by t1,e inspector o _ %f'irc�.
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" cove ale or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same .o :he permit issuing otiicc.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify
Estimated Value of Electrical Work:(When required by mw icipai policy.) (I"xpintion hate)
Work to Start: Inspections to be requested in accordance wit., yule IU, and upon completion.
1 cern under the a[ns acid penalties o er u that the information utr this apt cation is true turd cunrplete.
r�' l P 17',
FIRM NAME: //(� � J,,
Llc• No.:����
l.iccnsce: �[� � (/f{ Zell t' 7Signatur
LIC. NO.:.? / f,
7f applicable, enter exempt' in the liven a number line.)
kddress: �/eS T-- -tt�— //*� �• Buy. Tel. No.: GS �3
�WNSi�'S iNZ)UKANCE1,i'AIVE(~•. l amWkkart! thutite I
ease does nor i,c�e ic:iabiltty insurance coverage normally
?quircd by law. By my signature below,[ hereby waive ,his rc, iirement. 1 am the thee;; Otte) Clwner
)wncr,rAgenr ❑ owner's at;eta.
ignaturc Telep'uonc No. 1