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t 01 hi &MMUnwalit I af5fiZ1t4ll-IEttS Permit No.
�fztg Occupancy &Fee Checked
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BOARD OF FIRE PREVENTION REGULATIONS 5527 V. -IR 12.00 S i
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12100
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
KORTEI ANDOVER _ To the Inspector of Wires:
QM or Town of
The udersigned applies for a permit to perform t e electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address _
is this permit in conjunction with a. building permit: Yes _ No (Check Appropriate Box)
P;lrocse of Suildinc Utility Authorization No.
E.,csting Service Z� Amos vcits Overinead Uncgrnd No. of Meters
New Service Amps _1 Vcits Gv=_rr,ead � Uncgrnc r No. of Meters
Numaer of Feeders anc Amcacity
Location anc Nature of zircccsea Electrical `lerx
Totat
No. a ..ct _v -s I No. of Transformers KVA
No. at Lign ing Outlets
_ i
No. of Lighting xtures i Swimming ?an S^ ae- cmc. I Generators KVA
ii No. of Emergency Lighting
No. at Cil Sumers
Battery Units
ni.. .��.-on.orio C")utletS J �
No.
at Swimn Cu(lets
I NO. 0 Ga5 _urn ers
Totat
No.
cf Ranges
No. of Air C,.nc. tons
Heat Tota(
Total
No.
of Oiscosals
No.cr
( Pumcs "ons
K'•V
SoaceiArea Heaund
No.
of Oisnwasners -
No. of Orvere
Heaang Devices
KW
No. ct No. at
No.
of Water Heaters KW
i Sicns 3ailas:s
-,;ic
No. at Motors �otatP
OTHER:
FIRE ALARMS No. of Tones
No. of Cetection and
Initiating Oevices
No. of Scuncing Devices
No. of Self Contained
Oetec:;on/Sounding Oev ces
Munictoai other
'Local Connect(on
Law Voltage
Winnc
INSURANCE CCVEr;AGE: Pursuant :o the reeuirernents o- Massacnsa-s genera( Laws aie_
1 have a current Liaoiiity Insurance Policy inducing C:.r.o:e(ee Ocerattensu average gree !E55,a tialeecuiv3tenthe yca of coverage cy
nave suomtrea valid proof at same to the office. YES — N4 — I, i
Cttecxing the adprdoriate Cox.
INSURANCE = BCNO 2 OTHER = (Pease Scec::y) (Exoirauon atei
stimated Value at E!ectncai Work S Fnai
Inseec:(on Oate Racues:ac: Rougn
wcrx :o Start
Signed unser : enalues of pe uryLIC. NO. ILLI -----
FIRM NAME Llc. NO.
Licensee Signature (, p3 Pf3 373
Bus. Tet. No.
nA Alt. let. `1a.
Address
nt as re -
OWNERS INSURANCE WAIVER: I am aware that the L:C nsea CO?mot nave ins Csurance on naives coverage
r itsementa OwtneCutvala Age
au,rea by Massacnusetts General Laws. and that my sig
(Pease'
cnecx onel V
:eieCnone No. PERMIT FE. S
(Signature at Owner or Agenn
0
1 4 Date ..... .�.. �d l.... d
f NORT/{ 1
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�1 °+wry°
,SSACMuSE�
w
This certifies that ............ ... ..................... ...........
......[.G..��2 �,.....�,
has permission to perform
and
....... . ..... ,............
........... .011."1....
wiring in the but fling of .......... � . -Z :..........................................
at ................... 6i1Y.1.......Y............. .... . NortAn er s.
Fee ..... Lic. No'f �s
.......... ..........................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: ding Dept. PIN�Yr1surPAID
uqc �Dmuwnwf91ur of 10640= P$Mk No. �' ~. `".y3�
Erparttnrtti of Public $uftiq Octxlparxy `Fee Ctwdtal&;_
BOARD OF FIRE PREVENTION REGULATIONS 521 CSIR 12:00 M Pam billnk1
APP ICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CHAR 1100
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date %
or Town of NnRTH ANDOVFR To the Inspector of Wires:,
The udersigned applies for a permit to perform the electrical work described below.
Location (Street d
Owner or Tenant
Owner's Address
is this permit. in conjunction with a building permit:
Yes No 2:1 (Check Appropriate Box)
Purpose of Building
Utility
Authorization No.
Existing Service
Amps —J Volts Overhead ;.I
Undgrnd [Q No. of Meters
New Service
Amps _J Volts Overhead
'
Unagrno [ No. of Meters
Number of Feeders ana Ampaclty
Location and Vatureof r
ose Electrical WorK
No. of Lighting OutletsI
No. of Hot ',.cs
No. Of Transformers Total
KVA
No. of Lighting Fixturesi
Swimming Pc.oi Aocve•— In- r.
I
grro _ crno. _
Generators KVA
No. of Receotact• Outlets
INo. or Oil corners
I No. of Emergency Lighting
Battery Unita
No. of Switch Outlets
I No. or Gas 9�rrers
FIRE ALARMS No. of zones
No. of Ranges
I No. of Air C.:rc. Total
No. of detection and
:cns
Initiating Device t
No. of Oisoosala
I No.ol Meat Tota' .otar
Pur 'ons
-„s KW
No. Of Sounding OavlCss
NO. Of OiahwasMrs
SoacerArea +eaur.g M,%
No. of Sed Contained
Oeteetion/Sounaing Devices
No. of Dryers
I Heating Oev ces KW
Local -' Municibal --OtMr
_ Connection
No. of Water Heaters
KW
No. OI Nu it
I Signs °a lass
Low Voltage
Wiring
No. Hyaro Massage Tuos
I No. of Volcfs 701al NP
OTHER:
INSURANCE COVERAGE. Pursuant :o Ina requirements -,t'.tassac%sers ;eneral Laws
1 have a current Liability Insurance Policy incluamg Ccmc:etec Ccerauons Coverage or its substantial e0uivalent. YESNO
Checking the approOnate box. t over = 1
have suomUteo valid proof of same to the Office. YES = VO = It you nave cnOCKeO YES. please InatCale IM type of age py,
INSURANCE = 80NO = OTHER = (Please Scec:'.�) 9�
Estimated Value of E!octncal Work S (EAWa ton octal
Work to Start
Signed under •he nalltress of urs
FIRM NAME r .-- L
Licensee !qi�t cry
Insoec:ion mate ;;acr es;ec: Rough Final
Address oltrJa✓wvl`cl f/ * V 6W Bus. Tel. No. _77X O&S 6 2
All. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware mat the t-:censee tees nor nave he inaurage• coverage or its suostanttal equrvaNnt as re.
atureo by Masaacnusetts General Laws. ana that my signature on :r,is cermit application waives this reoulramertl. OwnW Agent
(Please ChecK Onel'
(Signatwe of Owner or Agents
"eieonone No. PERMIT FEE i
N° Il 367 Date/..:. 9 :%.......
TOWN OF NORTH ANDOVER
400 M' PERMIT FOR WIRING
` EE
19` ae_"' .
This certifies that '
.............................................................................................
has permission to perform -z-? ..� .4. �� ....
_� wiring in the building of .............................................................
at ...'.,J. ... G .�'"`'`` ................... . North Andover, Mass.
FO: ..... Lic. Noce' ...............
'�g lqp ELEcnucAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer