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01 he C&IM IIIRIiMMItl1 ofB Ptts Permit No.
je}ta=nd Of JIUJAir Occvpanry 3 Fee Checked •(Y
BOARD OF FIRE PREVENTION REGULATIONS sZZ7 MR 12:00 3M (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massaciusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
QQ* or Town of NORTH MOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number). VQ sun-Sgf OCR 90' ('_°7-I I
iy
Owner or Tenant
Owner's Address
C (Check A rcoriate Bax
Is this permit in ccnjun on with a building permit: Yes No Fp 1
Purccse of Building nYS�`" �n Utility Authorization No.
Existing Service Amos _J Vcits Overhead _ Uncgrnd I No. of Meters
New Service Amps —J `!tits Cverhead _ Uncgrnc i` No. of Meters
Numcer of Feeders ane Amoaclty
Lccaticn anc Nature of Prceosec E'.ectrcai Wc.,*c LJL
I – No. of Tansformers Total
No. of Lign:Ing Outsets No.c:..cs I K':A
Accve— 'n- —
No. of Lighting =fixtures I Swimming Poci grra. — --a.
I Generators KVA
i No. of Emergency Lighting
No. of Receotacie Cutlets No. of Oil turners I Sat ery Units
No. of Swttcn Outlets
No. of Ranges
No. of Disposals
No. of Oishwasners
No. of Orvers
No. of Gas Su e,_
No.pial
Air as
I No.cfea:Vs o.as otai
1:.
I
1 ScaceiArea-ieaar.e K%11
Heaunc -::ev:ces '-Gv
No. of No. cr
No. of Water Heaters KW Sicns a:iass
No. Hvcro %lassace 7uCs
OTHER: & /� I�n�►v1
No. of :ictcrs o:a: -'
FIRE AL.-kRMS No. of Zones
No. of _election anc
Initiating Cev ces
No. of Stunting Devices
No. of Sart Cantainec
OetectccniSouncing Oevices
Local i Municioat Other
Connecnon
Low Vettage
Wiring u rc--_ Q r
INSURANCE COVE^AGE: Pursuant m the reeuaements ct :tassacn::se-s ger.erai Laws _ _
! have a current Uaetiity Insurance Policy inchxing Carnc. ec Ccerattens Caveraee or its sucs:antral ecuivaient. YES _ NO _
have suorninea valid proof of same to the Office. YES ZNO = ;t you nave cnecxea YES. ptease inaicate the type of coverage oy
Cnecxing the aoR nate bOx.
INSURANCE BONO = OTHER = (Please Scec.tf) (Excitation Oatei
Esurnatea value of E:ecaical Worx S 1 l 'Do.
O v
Wcrx :o Start Inscec=en Cate Recues:ee: Rougn
Signea cancer :he Penalties of pertury:
=IRM NAM virf f./ary ✓Z Q� �L
!je ptlLL�✓p v✓ Signature
t�censee
Finai
UC. NO. ; A 117 P
UC. NO.
--
Bus. :91. NO.
Alt. :el. No.
ACoress
OWNER'S INSURANCE WAIVER: 1 am aware that tre i_,censee Cos not '+ave the insurance coverage at its substantialeauivalenAt este
Coles
cuirea by Massachusetts General Laws. ano :hat my stSrnature on iris =erit application waives this requirement. Owner g
(Please cnecx one) h152
nt
eiecrcne No. PERMIT FESS
(Signature of owner or Agenti 1-6567
Date .... 11�171...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
LO
M
This certifies that ......... ...... /..( n 1. JJ .....
.. .......................
has permission to perform .......... .......... ly.
.........................
wiring in the building of ....... Lc x/1 .......u.............'.o
.
at ... C1 .............. . North Andover, Mass -o
Fee... ...........
4J.. Lic. No..,PL.yM ..................................................
ELECTRICALINSPECTOR
C I" #- � � '3
WHITE: Applicant CANARY: Building Dept.
PINK: Treasurer GOLD: File