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Date.............>C' /
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .................... �4'r.....................
has permission to perform ..........: f� r J f
..................................................................
/ / .
n wiring in the building of L
/j
. _ at ......... :..................................... a............................ ,North Andover, Mass.
Fee. �.............. Lie. No....... S...0 ................... ...,. ! .1..t1
,1 a ELEC;'RICAL INSPECTOR /
Check #
11
(.,ommonwaal9 olcc)Vamachuda Official U�seyOnl;
_ 1JePartmenf o�.}ire �ervices
Permit No.
= Occupancy and Fee Checked I
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) J
APPLICATION FOR PERMIT TO PERFORIN ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
TLF,11 SE PRINT IN INK OR TY PE ALL INFO MATION) Date: / o-), - .;z $ - O S
City or Town of': &L-
By this application the undersigned gives notice oF,�-t,7L ' or her intention to
Location (Street & Nurgber) _�� 9j
Owner -or Tenant
To the inspector of Wares:
rfprm the electrical work described below.
Telephone No.
Owner's Address _
Is this permit in conjunction with a building permit? Yes ❑ No Check Appropriate Box)
Purpose of Building_ _— Utility Authorization No.
Existing Service Amns Volts
New Service Amps ___ / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead Und.rd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
INo. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
o. o , mergency ig tmg ---�
�_
rnd. rnd.
Battery Units
' No. of Receptacle Outlets
No. oi' Oil Burners _.
_
FIRE ALARMS No. of Zones
iNo. of Switches
No. of Gas Burners
o. of bairn ron and
InitiatinDevices
Nn. oI' Ranges
Total
Na. of Air Cond. Tons
No. of Alerting Devices
�No. of Waste Disposers
Heat Pump Number Tons : .KW _ _
No. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
LocayQ-"u cipal ❑ Other
Conne on
No. of Dryers Heating Appliances KW Security Syyst__e `
�rel4)Tv-ices �F-
or Equivalent
No. of WaterK W No. of No. of Data Wiring:
Heaters Signs Ballasts No. of Devices or Equivalent
No. Total HP Telecommunications Wirng:
cr „•,
OTHER:
.l Attach additional detail desired or as required by the Inspector of {fires.
Estimated Value of Electrical Work:y 74 (When required by municipal policy.)
Work to Start: C�5-o Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO -Q GE: Uniess waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [A BOND ❑ OTHER ❑ (Specify:)
f certif},'under the pains andpenalties ofperjury, that the information. on this application is true and complete.
FIRM NAME: '
1�T" c� CurcL--.4 SerVccQs LIC.
Licensee: Jf //c�' T,0' Signature �� LTC. NO.: tcc
(If applicable, enter "exempt" in the license number lin - Bus. Tel. No.: a3 a
Address: / (� L /nTvi7 2. /1-011[,5 X/}- 0,36(19 Alt. Tel. No.: _
*Pe ?v1.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) Elowner E]owner's agent.
Owner/Agent PERMIT FEF,: $
Signature
—_ Telephone No.
33h
�3 \ ,
Department of Public S('.
_ - One Ashburton Place, Rm 1'.
Boston, Ma 02108-1618
License: CERTIFICATE OF CLEARANCE
Number: SS CC 002577 Expires: 12123/2009 fl
WILLIAM M TAYLOR JR
I8 CLINTON DR
HOLLIS, NH 03049
DPS .CAI 0 50M.07/07-PC9490
DEPARTMENT OF PUBLIC SAFETY
CERT!r"ICATE OF CLEARANCE
Numher:'SS CC 002577•
lug Expires: 1 212 312 00 9 Tr. no: 893.0
S -License: ADT SECURITY SERVICES
WILLIAM M TAYLOR JR
18 CLINTON OR
HOLLIS, NH 03049
Commissioner
COMMpNWEALTH OF MASSACHUSETTS
1.
REGISTEREp STEM TECHNICIAN
ISSUES THIS LICENSE TO
WILLIAM M TAYLOR JR
27 S'fONENENGE RD
.APT 6
NH
CONDOHOERRY D3053 -2457 y
10094 07/51/10 291168
Tr. no: 89
IQ2p top fol
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DIG SAFE CALL CENTER: (8
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