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- -- `�---- ----- - 210/047.0-0106-0000.0
Date. ..........
f MORTM �,
of°.';�`"-.•'O0 TOWN OF NORTH ANDOVER
' PERMIT FOR WIRING
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This certifies that .............. L..L.....: ......:F:...
has permission to perform (Tr-
................. ...............................
wiring in the building of............... ..................................................
at......-�,.:............!....... .... ................................ North Andover,Mass.
Fee..3Lic.No..2�.............IZ .L�/�1-1.4�
EImcrmCALINSPECTOR
Check # Z
8771
2012 Massachusetts]Electrical Code Amendments 527 CMR 1.2.00§Rule 8: In accordance-with theprovisions ofM.G.L,c,143,§,3L,the
\\\\ permit application form to provide notice of installation of wiring shall be uaiforin throughout the Commonwealth,and applications shall be filed a
on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c, 166,§32,an
electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shall be limited as to the time of ongoing construction.activity,and maybe deemed_by-the.Inspector_of_Wd res abandoned.and.invalidaf-he_- -
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written
application,an extension of time for completion of work shall be permitted forreasonable cause.A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Seettons.74 and 75 of Chapter 238 of
the Acts of 2012.The purpose of this act is to promote job,growth and long term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effector existence"during the qualifying period beginning on Angus 15,2008-and extending through August 15,2012.
rPerimenit
—Permit/Date Closed: _ / /� ***Note:Reapply for new permit
[ED] Extensiontact—Permit/Date Closed:
Commonwealth of Massachusetts Oficial Use Only
Department of Fire .services Permit No. ov) 7 /
ot
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] tl1d1ehl,nk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PI.F.'A.SE PRINTIN INK OR TYPE ALL INFORMATION_) Date: - 2 j� —07 f
City or Town of: NORTH ANDOVER 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) s 7 yl�,vZ;-
Owner or'renant ^ , ` Telephone No.
Owner's address
Is this permit in conjunction with a building permit? Yes ° ❑ (Check Appropriate Box)
Purpose of Building g�.._.._, i'h ;e 4 „L,��t r�� Utility Authorization No.
Existing Service Zao' amps Z YGVolts Overhead ❑ Undgrd E1 No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ji✓. �,�,,L e h
Com letion of the followin table tnav he waived by the la ector of Wires.
F No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ota
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o Emergency Lighting
ends end. BatteLl Units
No.of Receptacle Outlets L No.of Oil Burners FIRE ALAR1115 No.of'Zones
No.of Switches Z No.of Gas Burners o.of Detechon an
Initiatin Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers eat Pump Ium er ons o.o c - .ontatne
Totals: Detection/Alertin Devices
No. of Dishwashers Space/Area heating KW Local❑ municippil municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Svstems:*
No.of bevices or Equivalent
o.o ea KW °'° � a ° Data Wiring:
Heaters No.of Dvices or Equivalent
Signs Ballasts
No. Ilydromassage Bathtubs___JNo.of Motors Total HP 'e ecommuntcationsWiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as regWred by the inspector of f'ires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: f--;?,6-0 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
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.
CIiECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: �. J� I Signature : Ly�l1Cy�{�N—_--O.:
tlf rlrl+/ier+hle, e^!t v "e.rentpl �Atlite license tntmberline.j Bus.Tel. IVO.: 2 i e
Address: �i t - 4r—-7,-
F Alt Tel. No.:
*Per M.C;.I.c. 147,S. ? -61,security work requires Departm of Public Safety"S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee clues nett have the liability insurance coverage nonnally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑ owner's a gent.
t`)wtlprlApot
Telephone No. PERMIT FEE: �
-C9 ��