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Date ... �.'/ ( ........— 1, .D...
.............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
IThis certifies that ........1.-.../�..................................................................
has permission to perform ......... 114&1 . .....
......... ..
wiring in the building of ............ .....................................
at .......... ...... .............. :� North Andover, Mass.
Fee. ��.04.... Lic. No.../.C(.V?.( . ................ Ii -11A
E[,ecrwcu.INspacroii
Check #
93U''
Commonwealth of NamacLiettA Oficial Use Only
e[Jepartmeitt of ,}ire Servi.cei Permit No. G%
Occupancy and Fee Checked
r BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be peerformed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYP ALL INFORMATION) Date: X� /,5/ to
City or Town of: 460yer 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) C t 11 C Yt..PV i n 2-c_4
Owner or Tenant 7 U 21 A Telephone No.
Owner's Address -71 LVIC Uf it1R Z 8
Is this permit in conjunction with a building permit? Yes ❑ No
Purpose of Building Utility
Existing Service Amps / Volts Overhead ❑
New Service Amps / Volts Overhead ❑
�i Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: f2, y -o, 1(,A r
(Check Appropriate Box)
ition No.
Undgrd ❑
Undgrd ❑
No. of Meters
No. of Meters
Coninletion ofthe followinn tahle may ho ivnivad by dm hicnorinr of tVirnc
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
_76oveIn-
Swimming Pool rnd. ❑ rnd. ❑
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
[No.
No. of Switches
No. of Gas Burners
No. of Detection an
Initiating Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Num er
Tons
KWNo.
of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Si ns Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Fe ecommunications Wirmg:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wh-es.
Estimated Value of Electrical Work: �1 (When required by municipal policy.)
Work to Start: 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.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of pet jury, that the information ort this application is true and complete. r j
FIRM NAME: Le_no3 Tnc — 0IGf t71 COrYLU-1^ ` rr chncl0n j LIC. NO.: I '/'-/
`1 LI VC
Licensee: ft e ( 6er Lc io oS Signature LIC. NO.:
(Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.:
Address: Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
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
P� c Signature Telephone No. PERMIT FEE: $ 6
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6L-02-2010 07:17 From:ALARM COMPUTER TECH 508 673 7223 To: 19786889542
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FALL RIVER, MA 02721 DIG SAFE CALL CGN'TgR; 10001344-72.13
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