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No. _ 2 Date
Check # � 61
2.#-, 665
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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Date ...4 .2 Z..'.:,.p. P..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... 61� l%JK
....!7 ......I. C ....2.....D.....�...�.
I.............................
has permission to perform . ,�..�l.. L-�,� S�% ...... &ri
....................
wiring in the building of . NC��. z��i:$..../—/ fi9.!0 .......................
at ....J` /� ,�fic - 1.��t . ....................... North Andover, Mass.
Fee../' ` ...... Lic. No/7'S °2 lX .............. X1K .... -. -
ELE ICALINSPECTOR v
b 7�
Check # _
88LI0
l.ommoniveakk of Mad-4ac4wetb Official Use Only
� � /n
:.� cc� Pennit No. C
Apartment of c'77 im Servicee
Occupancy and Fee Checked
X11.
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
1!1 work to be performed in accordance with the Massachusetts Electrical Code (MEC); 527 NIR 12.00
` �OF R LTIO-`� Date:(.PLt.,l.SEPRIVTL\[.NC .I:
Citi or To��n of: To the Inspector Wires:
13', 'Jlk application the undersigned gives noir;,e of his or her intention to perforin the electrical work described below.
Location (Street & Number)
ON% mer or Tenant
!�
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Lxisting Service Amps / Volts
4
New Service Amps / Volts
.Number of Feeders and Ampacith
Location and Nature of Proposed Electrical Work:
I
Yes ❑ No ❑
Telephone N
(Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
ContDletion of the following table nnav he waived by the lnmecior of bVires
No. of Recessed LumIinaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No, of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool grad. ❑ rad. �
: o. o Emergency Lighting
Batten' Units
No. of Receptacle On
No. of Oil Burners
FIRE ALARMS No. of Zones
No. of Switches I
No. of Gas Burners
No. of Detection an
Initiating Devices
No. of RangesNo.
�
of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pum
Totals:
Number
� .................................................................
Tons
KYN'
i o. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal El Other
Connection
No. of U; era
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KWNo.
Heaters
of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
lov /�j �,,— .Attach additional detail if desired. or as requiredby the Inspector of Wires.
listimatcd \ glue ofl;lect-ical \Fork:L'��=— (When required by municipal policy.)
\\ ork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1\SURA,NCE .,R G .: Un',ess )�aived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liabilih insurance including "completed operation" coverage or its substantial equivalent. The
uncicrsi<lned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
0-1FCK0\E. INSURANCE ❑ BO`D ❑ OTHER ❑ (Specify:)
I c•ertiji•, under the pains and penalties ofpeijury, that the information on this application is true and complete.
1,1RN1 NA.1E: -� LIC. NO.:
Licensee: ��r1i Signature_ IC. NO.: 17S
(Ifapplicable. enter "exemppt" to the lice se ran?be •,1ij{ne. BUs, Tel. No..
:Address:, ; I Ll/ % /t . �iJ ` Alt. Tel. No.4211T-1901-1�7TI'70W,
*Per M.G.L. c. 147, S. j �-61. security work requires Depa Tient of ublic Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage nonnally
rcquircd b\ lays. BV my (signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Ow ner'Aocnt
Si -1131111-0 __ _ 'Telephone No. PERTHT FEE: S