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DEPARII<W0FPURUCS4= Permit No. �J`✓ ��
BOARDOFFMPREVFNHONRBGUTAT7ONS5raM12-MJ
Occupancy&Fees Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 2l� j
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / t�/
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform he electrical escribed below.
Location Street&Number) � vwo U�—
Owner or Tenant f'0
Owner's Address
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
Purpose of Building Utility Authorization No. V
Existing Service F AmpizaLMOVolts Overhead Underground M No.of Meters
New Service Amps Volts Overhead Underground [Z3 No.of Meters
Number of Feeders and Ampacity ������, � ie4q
Location and Nature of Proposed Electrical Work
No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total
KVA
No.of Lighting Fixtures Swimming Pool Above Below Generators KVA
ro ground
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switch Outlets
No.of Gas Burners
No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
lo.of Disposals No.of Heat Total Total No.of Detection and
Pumps . Tons KW Initiating Devices
No.of Dishwashers Space Area Heating KW No.of Sounding Devices
No.of Self Contained
Detection/Sounding Devices
No.of Dryers Heating Devices KW Local Municipal Other
Connections
ater Heaters KW No.of No.of
SignsBailasis
dro Massage Tubs No.of Motors Total HP
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Telephone No. PERMIT FEE$ ���.
Signature o caner Or Agent
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: I f S U/ QUANTITY PUMPED 1000 GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE__JZMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
S='uTL14li -.00IPE'D BY: !� ✓�
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COMMENTS:
of Nut'
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CONTENTS TRANSFERRED TO:
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