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;•� "�o� TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
has permission to perform ...
wiring in the building of ....................... ........ ..................................................
................... . North Andover„Mass.
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Lic. NFee&o.............. �Z� ..................................
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ELEcrR1cALINSPE4TOR
Check Il ��`//
(.arnrnonrueaaA o/ I//adearjuaw(h For Office Use Only
(Rev. 11/99)
Permit Number.
.1J P of J`ire occupancy & Fee �SCV
/
BOARD OF FIRE PREVENTION REGULATIONS /
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(ALL WORK TO BE PERFORb= WrM nM MASSACHUSETTS ELECPRICAL CODE Sn CMR 12:00)
PLEASE PRINT IN INK OR TYPE ALL INFORMATION
Date: /G — /7. w 5
— City or Town of: . 'AI, rr --L — To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location: (Street & Number)
Owner or Tenant:
Owners Address: S G.
Is this permit in conjunction with a Building Permit? Yes No o (Check Appropriate Box)
Purpose Of Building:Z / / Utility Authorization #
Existing Service: 2�� Amps �I_:?�oits Overhead Underground. ❑ # of Meters .�
New Service: _ Amps I Volts Overhead ❑ Underground.❑ # of Meters:
Number of Feeders and Ampacity:
Location and Nature of Proposed Electrical Work:
No. of Recessed Fixtures
No. of Cell.-Susp. (Paddle) Fans
No. of Transformers Total KVA
No. Of Lighting Omflets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool: Above ground o in Ground o
# of Emergency Lighting Battery Units
No. of Receptacle Outlets / U
No. of Oil Burners
Fire Alarms # of Zones
# of Detection & initiating Devices
# of Sounding Devices:
# of Self Contained
Detection/Sounding Devices
Local ❑ Municipal Connection ❑ Otner ❑
No. of Switches / ()
6
No. of Gas Burners
No. of Ranges
No. of Air Conditioners TOTAL TONS:
No. of Waste Disposals
Heat Pump Totals:
Number. TONS: KW:
Security Systems:
No. of Devices or Equivalent
No. of Dishwashers
Space /Area Heating: KW
Data Wiring, No. of Devices or Equivalent:
No. of Dryers
Heating Appliances KW
Telecommunications Wiring: No of Devices or
Equivalent:
No. of Water Heaters KW
No. of Signs- ________# of Ballasts:
OTHER;
# of Hydro Massage Tubs
No. of Motors,_Total HP
INSURANCE COVERAGE: Unless waived by the owner, no permit for rfonnance of electrical work may issue unless the licensee provides proof of liability insurance
including 'completed operation' coverage or Its substantial equiv The undersigned certifies that such coverage is in force, and has exhibited proof of same to the perrni
issuing office. CHECK ONE: INSURANCE BOND O OTHER 0 Please specify:
Estimated Value of Electrical Work $ (When required by municipal policy)
Work to Start /G — "7 —e •5 Inspections to be requested in accordance with MEC Rule 10, and upon comoletion
I certify,, under the pains and penalties of perjury, that the Information on this application is true and complete.
Firm Name://►► - .�'� L L LIC. # /��1�f y 33
Licensee: // , ,. �� r � )ysr s Signatu UC. # A9,9 3
timberline) G y
—z/-f—
Aft. Tel. # r�
OWNHR'D INSURANCE WAIVER; I em aware that the Lleenaee doer not have time liability insurance coverage normally required by law. By my signature below, I nereby
waive this muirement. I am the (Moak one) Owner o OR Agent e
Signature of Owner/Agent: Telephone #PFRNIITFEE:630