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TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
This certifies that ............ . . .............................
........ ........ ..................... ... .......
has permission to perforrig_..,!�,,. ........ ......
wiring in the building of ..... ........................................................
at,. ......... ....... I ............ .............. North Andover, Mass.
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ELECTRICAL INSPECTOR
Check
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
01 Ile (90mmanweaffil of AnoonEflitoetts office Use Only
0I Department of Pithlic Saft�y Permit No.
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
OCCUIXincy & Fee Checked
3/" (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perforrix(i in accordance With the Ma-Aichusetts Electrical Code, 527 OAR 12:00 —
(PLEASE PRINT IN INK OR
City or Town of
The undersigned applies foi
Location (Street & Number)
Owner or Tenant I�
a permit to pericifill tile
10m, I .
Yo the Inspector of Wires*
Owner's Address 5� 2 /r
Zf
Is this permit in conjunction with a building I �t: Yes IJ No (Check Appropriate Box)
Purpose of Building 14-1 Utility Authori7ation No.
Existing Service Amps Volts Overhead 1:1 Undgrd No. of Meters
New Service ------Amps Volts OverheadF] Undgrd N6. 6f Meters
Number of Feeders and Ampacity
iLocation and Nature. of Proposed Electrical Work 1,40 T
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes G eneral Laws
I have a current Liability Insurance Policy including Completed Operation-, Coverage or itssubsmtial equivalent. YES 0 No 0! have submitted valid proof
of same to this office. YES 0 NO 0
If you have checked YES, please indicate the type of coverage by checking the appropriate box. -0 2 -
INSURANCE 1�1 BONDE] OTHERD (Please Specify) (Expiration Date)
Estimated Value of Electri I W rk $ Z;--r-CD Final
'Work to Start Inspection Date Requested: Rough
Signed under the penalties of perjury�, -A A
FIRM N,
Liceniee
JC. NO/��4=�
LIC. NO. -- -
Addire,,4U"&-iZAt� I 1#L41111 �1-7:�. �) Bus. Tel. No.
V . — 2 V-- — C,- -C
Alt. Tel, No. �k7� R.�o�
.OWNER'S INSURANCE WAIVER: I am aware that the Licens s not have the insurince coverage or its substantial equivalent as required by Massachusetts
.General Laws, and that my signature oil this permit appilication waives this requirement.. Owner Agent (Please check or*)
TOTAL
No. of Lighting Outlets
No. of Hot Tubs
No,- of Transformers KVA
No. of Lightinr Fixtures
Above In -
Swimming Pool grild, 1:1 gmd. F]
Generators KVA
,
No� of Emergency Lighting
No, of ReceMcle Outlets
No. of Oil Sumers
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No, of Detection and
Total
No. of Rame's
No. of Air Conditioner., Tons
Initiating Devices
I,, o, of Sounding Devices�
Heat Total Totar—
No. of Diyosals
No. of Pumps Tons KW—
No. of Self Contained
DetectionSounding Devices
No. of Dishwashers
Space/Area Heating_ KW
Municipal
LocalElConnection 1:10ti"r
No. of R=rs
Heating Devices KW
No, of Water Heaters KW
No. ot No� of
Sions Ballasts
Low'Voft—age
Wiring
No. dro fvlas�a� Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes G eneral Laws
I have a current Liability Insurance Policy including Completed Operation-, Coverage or itssubsmtial equivalent. YES 0 No 0! have submitted valid proof
of same to this office. YES 0 NO 0
If you have checked YES, please indicate the type of coverage by checking the appropriate box. -0 2 -
INSURANCE 1�1 BONDE] OTHERD (Please Specify) (Expiration Date)
Estimated Value of Electri I W rk $ Z;--r-CD Final
'Work to Start Inspection Date Requested: Rough
Signed under the penalties of perjury�, -A A
FIRM N,
Liceniee
JC. NO/��4=�
LIC. NO. -- -
Addire,,4U"&-iZAt� I 1#L41111 �1-7:�. �) Bus. Tel. No.
V . — 2 V-- — C,- -C
Alt. Tel, No. �k7� R.�o�
.OWNER'S INSURANCE WAIVER: I am aware that the Licens s not have the insurince coverage or its substantial equivalent as required by Massachusetts
.General Laws, and that my signature oil this permit appilication waives this requirement.. Owner Agent (Please check or*)