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M /y z 3.3 ANDOVER, a[ASSACMUSRffS 01810
6
N° 3 4 u 8 Date... .:.. G
t NORT1�
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
S.S CHUSE�
E
This certifies that ..............................
E
has permission to perform .... --
wiring In the building of - A
at .........................................- iy................................. .North Andover,Mass.
I .......... �... .. ...........................................
k ELECTRICAL INSPECTOR
Check #
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
THE COMMONWF.ALTHOFMASSACHUSEM Office 7r
DEPARTMEATOFPUBLICS4FE7Y JPennitNo. ` v
BOARD OFFMEPREVII\'RONREGUI ONS527CMR12:GU Q c
Occupancy&Fees Checked
APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location(Street&Number) J1,_ N CIO LA me—,-
Owner or Tenant Rober-V Su re-Ne._
Owner's Address S PJarQVe__ Large/
Is this permit in conjunction with a building permit: Yes 0 No M (Check Appropriate Box)
Purpose of Building iAp4�-Cn9-2 Utility Authorization No.
Existing Service Amps ---/47�O Volts Overhead O Underground No.of Meters
New Service A-91-2Amps�Volts Overhead Underground No.of Meters
Number of Feeders and Ampacity
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
rou groutd
No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units
Ao.of Switch Outlets
._._ No.of Gas Burners
fpo.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones
Tons
No.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
No.of Water Heaters KW No.of No.of
Si ns Bailasis
No.Hydro Massage Tubs No.of Motors Total HP
OTHER•
IrMranceCowrage.Rmant todr,tegt mviff8ofMasmchusetsarffjLaws
1.0awacunulLiabililylrwrar=PblicyinchKhngCompl&,Operations Cmerage oritsatbsuvialequivalent YES NO
Ibawa bnrittedvalidproofofsamelotheOffnce,YESM E2
lf)whawdre ed YES,pleaseindic&thetypeofcovrageby-
art.. the box
Ig
INNSURANCEE BOND M fflmII F71 (Please Spodfy)i
ExpirationDale
Estirrnted ValueotElectu�tl Wodc$
WorktoStatt �'2 D kq)xtionDateRequested Rough Final J�
Sigled underTr Rtf&es of
FIRMNAME �T IioeffmNo.
Lioffisee ?l �! Sigtahue r LicroseNo
L
Busu>essTel.No.
Address �. /"�a!/ca' a! 1 f_Cr/�_ /�7l Alt Tel.No.
OWNER'S INSURANCE WANER;IamawarethattheLioffw doesnothavethe*mstuanlw,00mWorits wbstantialeqtuvalentaslequnedbyNb%achusezGawA Laws
andthatmysigtahneonthispmrritapplicationwaivesthisrequituTu t
(Pleas,e ck onen Own + ® Agent \ p
Telephone No. till � 3-03$ PERMIT FEE$ O°
Igna ure o wn -or gen