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16 2 1 Date
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that ...... .........lel �AAIC... ................................
has permission to perform .................................................
...
wiring in the building of ...... '. ........ ........................
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at ..... X.6 ... ...... 5.T ........................ ............ ort over,
Fee .... Lic. No.'. ........ .? ............... . . ....
) / LECrRICAL INS
WHITE: ApplicantCANARY: Building Dept. PINK: Treasurer
�a-Qr�it`� ✓�/��> Office Use Only
�11P �IIIYI1nIIYilUPII�IIf c�lttf�ll�P II i Permit No.
}1 Occupancy &Fee Checked
iia i I�
Department of ubli� �afet
�y3 = BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90
(leave blank)
APPLICATION FORPERMITPERFORM ELECTRICAL WORK
o d Ip with Electrical Code. 527 CMR
( (PLEASE PRINT IN INK OR�TY/PEALL INFORMATION) Date _ �� 7
City or Town of fV . z�/LIVV lllt!5� Tq the Inspector of Wires:
The udersigned applies for a permit to perfoorrrm the electrical work described below.
Location (Street & Number) /' oL
v Owner or Tenant _ —7Z� 561& S-JI/V,67
Owner's Address
Is this permit in conjunction with 4 building permit: Yes Nn �]�( (Check Appropriate Box
f Purpose of Building Utility Authorization No.
Existing Service Amps —J Volts Overhead Undgrnd No. of Meters
4 rf r
New Service Amps _/ Volts Overhead Undgrnd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work V
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Above,—,
Swimming Pool
In- -
grnd. I_,
grad. _
Generators :VA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
1 No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Conc.Total
tons
Initiating Devices
No. of Disposals
Heat Total Total
No.of
Pumps Tons
KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
Local IMunicapal — Other
No. of Dryers
Hearing Devices KW
No. of No. of
_
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massaqe Tubs
; No. of Motors Total HP
OTHER:
3 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 SL NO _
have submitted valid proof of same to the Office. YES NO _ If you have checked YES. please indicate the type f cov,rage by
checking the apprapriate box.
Jt INSURANCEBOND _: OTHER — (Please Specify)
P /l/ (Expiration Date)
Estimated Valuer of Electrical Work $ -4�S:Z) t
Work to Start Inspection Date. Requested: Rough Final /��.JY �•�
i Signed under the Penalties,s`of p rjury: C�
FIRM NAME IJ 0 S` /k/G/�v /
LIC. NO.
Licensee ,rSn�� J Signature / LIC. NO.
_l� /G ��L /V v �S� Bus. Tel. No. n
Address
Alt. Z. No. L1,/
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equival t as re-
quired by Massachusetts General Laws. and that my signature on this permit aoplicallon waives this requirement. Owner Age
(Please check one)