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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
S,cc L, tl,T-,/ 5,&,e vie F- 7—& C
This certifies that ....... .......................................................................
has permission to perform ...
� Em tl C"(f 1* 0
wiring in the building of ...................................................................................
at ....... .................... . North Andover Mass
Fee.��. Lic. No..3.-1.44 0 .......................
iCA
ELEcrR ( LINspEcrOR
Check #
7196
Com,monwealth of Massachusetts Official Use Only
Yermit No.
Department of Fire'Services
Oc pancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS �Rev"9/051- (leaeblank)
.APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 OMR 12.00
(FLE A SE PI?JNT IN 1ArK OR -. TYPE A LL INFORMA TION) Date:
Ci�y or To,,�Yn of:.
To the Inspecior oj. rVires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described . below.
Location (Street*& Number) f;,O��S M Nko
Owner or Tenant
Owner's Address
Is this permiVin conjunction with a building permit?
Pill -pose or Building,—
Existing Service Anips Volts
New Service Amps Volts
Number of Feeders and Ampacity
Yes N o 1-7V
141
Telephone N
(Check Approprinte Box)
___ — Utility Authorlmition No,
OverliendF1 UndgrdFj
oyerfieadEl - Undgrd'R
No. or meters
No. of Meters
Location and Nature of Proposed Electrical Work: Installation of Security and or Fire alarm systems
Completion of thefollowiney able may be waived by (he [it ectnr n1*111ir—
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers I(VA
No. ofturninaire Outlets
No. of Hot Tubs
Generators I%',V'A
.40. of Luminaires
Above In- Ej
Swimming Pool grnd.. grnd.
No. of Emerge—ney Liorliting
Units
i N ceptacle Outlets
to of Re
No. of Oil Burners
-Battery
FIRE ALARI;
ones
No. orSwitches
No. of Gas Burners
No. _ofDetection and
-InitiatinX Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of.Al.erting Devices
te Disposers
Heat I
No. of Se1F
-Coniained
T
Detection/Alerting Devices
No. of Dishwashers
Spqce/Area Heating KW
L o c a I 'tCy'o-ul a 1
Offier
11
6. � r D r:;
Heatinp� Armliances I(W
Security Systems-.,* ),9
4 Aj -Y�Ces or Equivalent
No. of Water KW
INO. of No. of
Data Wiring:
. Heaters
Signs Ballasts
No. of Devices or Eguivilent
No. Hydroinassage Bathtubs
No. of Motors Total HP
Telecommunications wiring.
No. of Devices or 17,quiva6t_
OT HER:
L9 o 1,) a
Attach additional det ' ail if desired, at as required by the Inspector of lVires.
Estini'ated Vnlue of Electric . alWork: (When required by municipal policy.)
Work to Start: E-, 47 -_ S 1� f Inspections to be requested in accordance with MEC Rule 10, and upon cornpletion.
INSURANCE COVERAG less waived by the owner, no permit for the performance of electrical work may issue' unlcss
r
the licensee provides proof of liability insurance including "completed operation" coverage or its substantia, equivalent. The
undersiqncd certifies that such coverace is* in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND R OTHEREI (Specify:)
I certify, under the pains andpenalfies ofperj,,�,ry, that the inj'oonaliott oil this application is true and complete.
FIRM NAM E: ADT Security Services, Inc.. LIC. NO.: 1533 C
Licensee: Kenny Wong Signature LIC. NO.: 5966D
applicable, enter "exempt" in the license number line.) Bus. Tel. No.., 603.-594-5900.—
Address 18 Clinton Drive Hollis N.H. 03049 Alt, Tel. No.: 603 -594 -59 -U --
*Security System Contractor License required for this work; if applicable, enter the license number herc: SS CC 00 1975
OWNER'S INSURANCEWAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my sil-nature below, I hereby waive this requirement. .1 am the (check one) 0 owner E] owner's agew
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