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3391
Date..�� .... I ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
law -
This certifies that ....... L/" ........ ............................................
has permission to perform
.........................
wiring in the building of z ................. ........ �f� ... —11�-
.............. .......................
77 . . . .................... . North Andover, Mass.
at ...... d.!F .....................
....................
Fee..................... Lic. No . .......... .. .......... ........ ..................
Check # 21 )��ELECTRJCAL INSPECTOR
7
uFficiai use uniy
Permit No. 3F91
Occupancy & Fee Checke&
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
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)
Town of North Andover
The undersigned applies for a permit to pe�orrn the electrical work described below.
Location (Street & Number- a ?-N C--';P-'JC-JG C V�-
OwnerorTenant
Owner's
Date 60 - '9 1 - C:! -.-.L
To the Inspector of Wires:
is this permit in conjunction with a building permit Yes 0 No ri,�(Check Appropriate Box)
Purpose of Building Utility Authorization
E)dsting Service_2c_C..) _Amps 1(j(412Z-C-2 Voits Overhead 0 Undgmd 4;i
e
New Service Amps__—_----Yoits Overhead 0 Undgmd El
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Meters. I
No. of Meters
OTHER:
INSURANCE COVERAGE- Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent Qo� No
have subimitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
dNS1G—RANCD= BOND = OTHER = (PleaseSpecify) (Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the fValties pf perjury:
FIRM NAME 4 1 L e.&4 LIC. NO.
Lkensee 23 -Signature
Z— LIC. NO.
Bus. Tel No. tDo
Adclressa�a �e r ?_,j -��Q G 3t;� Alt Tel. No.
OWNER;S INSURANCE WAIVER: I am aware that the Licenses 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 (Please Check one)
ce-
Telephone No. PERMITfEE $&-0- -
(Signature of Owner.orAgent)
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above 0
In 0
No. of Lighting Fixtures
Swimming Pool
gmd 0 gmd 0
Generators KVA
4
No. of Emergency Lighting
No. of R�ceptacles Outlets
No. of Oil Burners
Battery Units
No. of Sviitch Outlets
No of Gas Burners
FIREALARMS No.ofZone
No. of Detection and
Initiating Devices
No. -of Ranges
Total
No of Air Cond Tons
Heat Total Total
No. of Diposal
No.
Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
Detection/Sounding Devices
0 Municipal 0 Other
A
No. of Dishwashers
Space/Are Heating KW
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Sians
Bailases
Wiring
No., Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE- Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent Qo� No
have subimitted valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box
dNS1G—RANCD= BOND = OTHER = (PleaseSpecify) (Expiration Date)
Estimated Value of Electrical Work$
Work to Start Inspection Date Resquested Rough Final
Signed under the fValties pf perjury:
FIRM NAME 4 1 L e.&4 LIC. NO.
Lkensee 23 -Signature
Z— LIC. NO.
Bus. Tel No. tDo
Adclressa�a �e r ?_,j -��Q G 3t;� Alt Tel. No.
OWNER;S INSURANCE WAIVER: I am aware that the Licenses 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 (Please Check one)
ce-
Telephone No. PERMITfEE $&-0- -
(Signature of Owner.orAgent)