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•,. �+�ie V' MInnowfalt of Massar4natto Permit No. /C �-
' 11toa tmmt of Public
� �itfttll Occupancy � Fee Checked 5 U
;i
4 BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 3M peeve blank)
4
APPLICATION
.,,�.. FOR PERMIT TO PERFORM ELECTRICAL WORK
AO work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
.0 of lbwn of—NORTH ANDOVER To the Inspector of Wires:
the uderaigfled applies for a permit .to perform the electrical work described below.
L66ilon (atrsbt t!i Number) ._ LnY4� 17 ,% tJ,,A1,dZZsi rXz p4
dwrrbr or'I'bnlitnt -- _ GOLbNi d4G L �T F. ?,/NLAI 7'
OWner's Address --10 y� / J �/,�L J✓
is this 04rmlt in conjunction with a building permit: Yes ❑ No ❑
(Check Appropriate Box)
Purpose.of
Building Utility Authorization No. 40 y
Bxisting Service AmpsVolts Overhead ❑ Undgrnd ❑ No. of Meters
Nes► —service -,26 Amps ,Z ?J. Volts Overhead Undgrnd ❑ No. of Meters
(Number of f=eeders and Ampacity
Location and Nature of Proposed Eleetncal Work :1�,kj j / :LZ& tb V ,*a �s SG/r, c i1 e_ �.
,- SIV6 cc
No, of Lighting Outlets No. of Hot Tube No. of T}anaformers Val
KVA
No. of Lighting Fixtures Swimming Pool Above In.
r F OtHEA:
4..
INSURANCE COVERAGE: Pursuant to the requirementi of Massachusetts general Laws
I hit" a Current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES �NO = 1
have Submitted valid proof of same to thet.Oflice. YE C54 NO Z If you have checked YES, please Indicate the type of coverage by
Checking the appropriate box.
INSURANCEBOND C OTHC (Please Specify)
" . f (Expiration Date)
LsstIMatid Value of Elseirleal Work S
Work to Start Inspection Date Requested: Rough Final
., Sighed under the Penalties of perjury: s
. FIRM NAM
E LIC, NO.
Lkans Signature LIC. NO.
Bus
Alt
Addrt;iee :.,Y. 1 "— b t`�70'"t/ L J 1 �,Q�f) 9i /� . Tel. No.
Alt. Tel. No.
' F 6WNEA'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or Its s bstsntlal equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please Check one)
Telephone No. PERMIT FEE S
(Signature of Owner or Agent)
x-5565
gmd. ❑gmd. ❑
Generators KVA
NIS. of Recep4cle Outlets ,
No. of Oil Burners
No. of Emergency Lighting
Battery Unite
Nd. 6f twins Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
LocalMunicipal ❑ Other
❑ Connection
No.. of Ranplls !'
No. of Air Cond. Total
tons
No. of Die poeals
Heat Total Total
- No.of Pumps Tons KW
No, of Dlshwashirs
Space/Area Heating KW
No. of Drytitrs
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No, Hyde/ Massage lobs
No. of Motors Total HP
r F OtHEA:
4..
INSURANCE COVERAGE: Pursuant to the requirementi of Massachusetts general Laws
I hit" a Current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES �NO = 1
have Submitted valid proof of same to thet.Oflice. YE C54 NO Z If you have checked YES, please Indicate the type of coverage by
Checking the appropriate box.
INSURANCEBOND C OTHC (Please Specify)
" . f (Expiration Date)
LsstIMatid Value of Elseirleal Work S
Work to Start Inspection Date Requested: Rough Final
., Sighed under the Penalties of perjury: s
. FIRM NAM
E LIC, NO.
Lkans Signature LIC. NO.
Bus
Alt
Addrt;iee :.,Y. 1 "— b t`�70'"t/ L J 1 �,Q�f) 9i /� . Tel. No.
Alt. Tel. No.
' F 6WNEA'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or Its s bstsntlal equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please Check one)
Telephone No. PERMIT FEE S
(Signature of Owner or Agent)
x-5565
T
1009
V6
0
..........
'�SACHU
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
0
This certifies that ........ 700 ....... tavew ..............
"
has permission to perform ......... ...... .....................
J�-
wiring in the building of .... ...... U.�-iA ..... I ..............................
at .... 4,-) 1 / 4
........................... .. ........ North Andover, Mass.
Lic. No. W-06 ................ *i�E-C-T' R*I*C'A"L' *1' N -S' P -E' C*'T*O'* R*...
(f 45 CA
06/20/47'Yl--.43 50. 0o PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer