HomeMy WebLinkAboutMiscellaneous - 24 FARNUM STREET 4/30/2018Date... ..P.7 . �,/
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�•�,�--•._�e �o� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that..A. 71,v �.. �
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has permission to perform .......... ..... ............. ....................................
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wiring in the building of ............l1,�(Q r� �� .....:� /�, r
................. ............................
ate...........0 North Andover,
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Fee./"gP)6. Lic. NOM (3� ,.. .. 0X O
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ELECTRICAL ItV6PECTOR
Check # (CJS^
4513
THECOAMOAREALTHOFAIfL MQAC SEM Office USA off.
DEPAR"FNIENI'UFPUBIIC,W ETY°permit No. -74
BOARDOFFMEPRE,VMYONREGUTATIONS.527(WI?l2 G►0
Occupancy & Fees Checked
APPLICATIONFOR PERART TO PERFORMELFECTRIC U WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TIiE,MASSACY1USSTS ELECTRICAL (:)DE, 527 cMR 12'06 '
(PLEASE PRINT IN INK ORTXPE ALL INFORMATION) Date S�Z O/(j 3
To the Inspector of Wires:
Town of North Andover: P
The. undersigned applies fora permit to perform the electrical work described below.
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Location (S,treet & Number) Z2/77 / 04) CJ /mol
Owner or Tenant Si Ze <
Owner's Address l Allm /fid v y�>N 1)dre" 61 91S .
Is this permit in conjunction with//a building permit: Yes. No (Cheek Appropriate Box)
Purpose of Building j les;d e/II P .Utility Authorization No.
Existing Service /00 Amps 2qO17—OV,olts Overhead Fn Underground No. of Meters 1,
New Service Amps / Volts OverheadUnderoround No. of Meters —W
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work /,✓, /'r ,1q d o'n SGr/i/f! �"1 �/'1ov
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Ligyting Fixtures
swimming Pool Above
Below
Ge ierators
KVA
round
found:
No. of Receptacle Outlets
No. of Oil Burners
No of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No., of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No: of Heat Total Total
Pumps
Tons
KW
Iniriating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW.
No. of Self Contained
�—�---
Detection/Sounding Devices
Local Municipal
F7
Other
No. of. Dryers
Heating Devices KW
Connections
No: of Water Heaters KW
No..of No. of
Signs
Bailasis
Na: Hydro Massage Tubs
No. of Motors
Total HP
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and that niy sg ian on flus pm=appka)on waives this togtmurlent
(Please check one) Owner Agent a
Telephone No. PERMIT FEE $ ! ��
Signature ot Uwner or Agent
Name -_-
The Commonwealth of Massachusetts
Qepa tment of Industrial Accidents
Office of /nvestigations
6oston, Mass ;:02111, ''
Workers' Compensation *urance Affidavit
Please Print
FaiAxe to secure coverage as: required under Section 25A or MGL .152 can lead to the imposition or cximinal penalties of,a.fine LIP. to -$I., 5w. pp
ahWor one years' imprisorrnent-as v4WLas_civil.penaltiesjn-tbelow da-STDP.vA)RK_ORDER2nd_afioe.d r
.understand that a copy of this statement may be forwarded to the Office of Investigations of:the DW fcir .Ve VerDfa Y astme I _
,. coverage Verification. r'
l do hereby certify under the pains and penalties of perjury that the information provA*d above ,is trine aW correct.
Signature Date
Print name Pbons.#
Official. use only do not write in this area to be completed by city or town official
City or Town Per A/Licensi
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O Building Dept
OCheck d immediate response is reguied Lcensi
nq Board
El 'Selectman's Dice
contact person: Phone #. Health .Department.
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