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TOWN OF NORTH ANDOVER
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p PERMIT FOR WIRING
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Fee.,;5......... Lic.No ....'J. ............................................................
ELECTRICAL INSPECTOR
check it
5282
-C\- Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. o?�a
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: June 8, 2004
City or Town�of: N. Andover,MA r To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 48 Riverview Road
Owner or Tenant Christopher Jennings Telephone No.781/864-7202
Owner's Address 126 Prescott Street
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No. 71741
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service 200 Amps / Volts Overhead Undgrd ❑ No.of Meters 1
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Service upgrade to 200 Amp
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
g g g rnd. rnd. Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of
No.of Switches No.of Gas Burners No. InDetection and
Initiatin Devices
No.of Ranges No.of Air Cond. 1 Tonal 3 No.of Alerting Devices
No.of Waste Dis osers Heat PumpI.Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal ❑ Other
p g Connection
No.of Dryers Heating Appliances .1{W Security Systems:
Y No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER: 71
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless 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 ® BOND ❑ OTHER ❑ (Specify:) Acadia&Hartford 1/01/2005
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: June 9,2004 Inspections to be requested in accordance with MEC Rule 10,and upon
completion.
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Fisher&George Electrical Co.,Inc. d go LIC.NO.: A5982
Licensee: John Fisher Signature Ar4gtt. LIC. NO.:
(If applicable, enter "exempt"in the license number line) to,
Bus.Tel.No.: 978-922-0675
Address: 6 Kernwood Ave. Beverly,MA 01915 Alt.Tel.No.:
F 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)❑ owner ❑owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.