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3573
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Date
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
.
....
d ..............................................
has permission to perform .................................... .........................................
wiring in the building of ...... ........................................................
at .. ........................... Z, North, A;dove Mosi
Fee .... ... Lic. No./ ............. ...
ELECTRICALINSPECTOR
Check # �>*n
4
Commonwealth of Massachusetts official Use Only
I P. u
Department of Fre Services Permit No. 3J-7-3
BOARD OF FIRE PREVENTION REGULATIONS : Occupancy and Fee Checked
/ [Rev. 11/991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accord= with the Massachusetts Electrical Code (WC), 52 CMR 12.00
(PLEASE PRINT ININK OR TA'FQRtiIAT10NJ Date:
City or Town of: /1yer To the Lis ecl'o f 1;Yires:
By this application the undersigned givesI
tix' -of his or her in on to perform the electrical work described below.
Location (Street & Number) �o L�GAA of o Off'.
Owner or Tenant V Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No [J (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Senice Amps / Volts
New Service Amps ! Vohs
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑
Overhead ❑
Undgrd ❑�
Undgrd ❑
No. of Meters
No. of Meters
Com letion o the Ulmvin tabl may b . d b t! 1 t iY'
No. of Recessed Fixtures
No. of Cra1-Susp. (Paddle) Fans
e e Harve v re ru ee oro fres.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
S�yimming Pool Above ❑ In- ❑
rnd. rnd.
o. o Emergency Lig ung
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. - Total
Tons
No. of Alerting Devices
b
No. of Waste Disposers
Hcat Pump
Totals:
Number
Tons KW
No. of Self- ontaincd
Detection/Alerting Devices
No. of Dishwashers
Spacc/Arca Hcating KW
Local ❑ municipal C1 Other
Connection
No. of Dryers
Heating Appliances KW
ecunty Systems:
No. of*Devices or Equivalent
No. o Water KW
Heaters
o. o o. of
Signs Ballasts
irin
Data Wiring-
g
No.
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Detiices or Equivalent
OTHER:
AM a&1itional detail if desired, oras required by the hupeetor 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 evtibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiation Date)
Estimated Value of Electrical Work: $ (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 certify, under the pains and penalties of perjury, that Me information on this application is true and complete
FIRM NAME: ADT Security Services 111 Morse Street, Norr 0 , MA 062 LIC. NO.: 1533C
Licensee: John S. Bassett Signatu ; IC. NO.: 1533C
(Ifopplicable, enter "exempt"in the license nunrberline.)
Address: Bus. TCI. No.: 781-278-1131
Alt. Tel. No.: 7g1-278-1725
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
Signature Telephone No. PERAHT FEE. $ '
1,