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N TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that. AV/ .. .L
.........................
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has permission to perform . ..................
wiring in the building of...:-...1..6
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..............................
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at .... AZZY. ......... . North Andover, Mass.
Fee,, ........... Lic. No.
............. .....
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-ELEcrRICAL INSP'ECTOR'
Check # IJ
5233
THE COMMONWEAL TH OF MA�,
Deportment of Public Safety
BOARD OF FI'RE PREVENTION REGI
APPLICATION FOR PERMIT TO
All work to be performed in accordance with the
Q%Sse Print in Ink or Mm all Inlbnna&m)
Town of North Andover
f Official�Use only
�rT5 Permit No.
G
527 CMR 12:00 Occupancy & Fee Checked'
IRM ELECTRICAL WORK
Letts Bectical Code 527 CM 12:�ql
00Date baTo the Inspeabor of
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & NumberSAVif Mf i -L Rd. r
Owner or Tenant —1 HTne fc�///N}3ca
Owner's Address d w#.OW Aj 3U 3$
Is this permit in conjunction with a budding permit Yes (Check
Appropriate Box)
Purpose of Buddinc
Utility Authorization No.
Existing Service Amps Voits Overhead • Und and
9 No. of Meters
New Service Amps Voits Overhead • Und and
9 No. of Meters
Number of Feeders and Ampacity C+— (�
Location and Nature of Proposed Electrical Work7nf STkLLPrTION � F S02 c RimeI'"op �� L.
Of
of Lighting Fixtures Above • In
Swimmin Pool amd and Generators KVq
of Receptacles Outlets W� „ r n;i a,, , e . No. of Emergency Lighting
OTHER:
INSURANCE COVERAGE. Pursuant to the regwremen6ts of Massachusetts General Laws
♦ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
NZR4UbRdW valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND = OTHER = (Please Specify)
ExIll ' Value of O ti4 (Exp illon Dais)
Signed under the Pena �s of pertuwr�. �ePeetien Dabuesiad Qe"fih FI �(.,
FIRM NAME �f9/i1/IJntlJ> ELee%/��C ,Nt 1 ` _ f i1 LICL-07
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0
a
Addy.:: 6(7 if�yo�d S4, [Lm"i( Am "Ifs- ITW. Y la?— Q X73-9579
OWNER'S INSURANCE WANER: I am aware Valthe LlCWHIM does not s ubatanfLl haw the Inenmeg Goverage or iht
Ge Ord Laws. And thet ay slgea4yre on oftparrylR ePP�etlon wehres tlyht equivalent as roqulnd by Massyaehusetls
requireyym& Owner Agent (Reale Chock one)
(Slgymhyre of Owner or Apeaq TeNphone No, PERMIT FEE $
FIRE ALARMS No. of Zone
of Ran es
No of Air Cored
Til
No. of Detection and
Initiating Devices
of Di sal
Heat Total Total
No. Pumps
Tons
KW
No. of Sounding Devices
of Self Contained
of Dishwashers
Space/Area HeatingNoJ
KW
Detection/Sounding Devices
• Municipal • Other
Local Connection
of Dryers
Heatin Devices KW
No. of No.
of Water Heaters KW
ci...
of
„_-,-
Low Voltage
OTHER:
INSURANCE COVERAGE. Pursuant to the regwremen6ts of Massachusetts General Laws
♦ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
NZR4UbRdW valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND = OTHER = (Please Specify)
ExIll ' Value of O ti4 (Exp illon Dais)
Signed under the Pena �s of pertuwr�. �ePeetien Dabuesiad Qe"fih FI �(.,
FIRM NAME �f9/i1/IJntlJ> ELee%/��C ,Nt 1 ` _ f i1 LICL-07
�/i�
0
a
Addy.:: 6(7 if�yo�d S4, [Lm"i( Am "Ifs- ITW. Y la?— Q X73-9579
OWNER'S INSURANCE WANER: I am aware Valthe LlCWHIM does not s ubatanfLl haw the Inenmeg Goverage or iht
Ge Ord Laws. And thet ay slgea4yre on oftparrylR ePP�etlon wehres tlyht equivalent as roqulnd by Massyaehusetls
requireyym& Owner Agent (Reale Chock one)
(Slgymhyre of Owner or Apeaq TeNphone No, PERMIT FEE $