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BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00
pg -c;, C'^
Office Use Only
Permit No. Joe- 2—
Occupancy It Fee Checked
3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0012:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3-D& t I q717
M* or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform theA' (electrical work described below.
Location (Street & Number) /99 I ' �/{l It S C/4 S t—
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit:
Purpose of Building
Existing Service /00 Amps / _i)_o S' Volts
New Service Amps _ I Volts
Yes J1 No ❑ (Check Appropriate Box)
Utility Authorization No
Overhead t-1� Undgrnd ❑
Overhead l_ I Undgrnd ❑
No. of Meters f
No. of Meters
Number of Feeders and Ampacity 1 S9 j
Location and Nature of Proposed Electrical Work e wt r -C— t� ��S 4- Ou4te—Ers —1�,7 n toeG(
r le-. L-14 -tor co� 7.P %� �� l /1c�a P/v'
No. of Lighting Outlet
tal
g g s No. of Hot Tubs To
OTHER: '
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES SENO = I
have submitted 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 v� BOND OTHER Z (Please Specify) CJ ( Q
Estimated Value of Electrical Workl Q 000 (Expiration Date)
i
Work to Start .Ti % l gq% Inspection Date Requested: Rough Final wr !<� Iva y/ �1
Signed under the � Penalties of perjury: j
FIRM NAME .J M S "e F ! =C.�Yr c w f /
5-e rV/ C Q UC. NO.
Licensee VC e ry S t SignatureLIC./ NO. A/d �S6
,f� Bus. Tel. No.
Address /ter 0L_ Bd_�C � 7 CJ «P /�le f^."CGtI�� �r ` Alt. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial 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 5
(Signature of Owner or Agent)
X-6565
No. of Transformers KVA
No. of Lighting Fixtures %]
Swimming Pool Above In-
grnd. ❑ grnd. ❑ I
Generators KVA
-1
No. of Receptaclb Outlets s-
a
No. of Oil Burners I
No. of Emergency Lighting
Battery Units
No. Of Switch 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
Local Municipal ❑ Other
❑ Connection
No. of Ranges
No. of Air Cond. Total
tons
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
I
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No. Hydro Massage Tubs
I No. of Motors Total HP
OTHER: '
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES SENO = I
have submitted 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 v� BOND OTHER Z (Please Specify) CJ ( Q
Estimated Value of Electrical Workl Q 000 (Expiration Date)
i
Work to Start .Ti % l gq% Inspection Date Requested: Rough Final wr !<� Iva y/ �1
Signed under the � Penalties of perjury: j
FIRM NAME .J M S "e F ! =C.�Yr c w f /
5-e rV/ C Q UC. NO.
Licensee VC e ry S t SignatureLIC./ NO. A/d �S6
,f� Bus. Tel. No.
Address /ter 0L_ Bd_�C � 7 CJ «P /�le f^."CGtI�� �r ` Alt. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial 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 5
(Signature of Owner or Agent)
X-6565
1062
�o 7
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
c This certifies that .....!./�............ E2 2 t.�.4... �itR .............................
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has permission to perform ... //dr -� its, P /at1�.t!� C!+l
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wiring in the building of ..Om2rzvLs Cor ¢
IS att....ties , North Andover, Mass.
Fde..?oa..... Lic. NoA.iR.S.S9..... !'.' .......
EL6CTRICA INSrECTOR
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WHITE: Applicant
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CANARY: Building Dept. PINK: Treasurer