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Date./4t 4fi . t ....
N° - 3431
O -•`1O ra~O
o. TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
1 j
This certifies that ....... I ....� ............................................. r J.:.................
has permission to perform ......: �.!..!. 7 /) a, ? �
..........................�...... P................
wiring in the building of ........�.. !rA:....A-4...................................................
at ............................1.}:� `"'................................... ...... �orth AndoverefV ass.
Fee. �..J...
..�!�`f Lic. Nod.........: '........
/ LECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
40
ILI Commonwealth of Atmachusetts
Q
- ( Department of Foe Services
BOARD OF FIRE PREVENTION REGULATIONS
official UZCal
Pasait Na
OmgM t: j and Fc Che:lmd
Lem 111991 nmm bimki
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work- to be pefformed in ,ccmd=w&dMMz=tM= EL=UiCd CQae(l, Zc 27 CMR UM
(PLEdSE PROW'YM OR TYPE INFO Old Date
City or Town of: To the Ilupecwr WAV
By this application the ,gives notice of hu oar �j mtattiog to pe:form � descried below.
Location (Street & unberl ds.fJ� �� / /=JI h / /"
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit.' Yrs ❑ No (T (Check AD ropriate Box)
Purpose of Building Utility Authorb= ion Na
E :fisting Service Amps ! Vohs 0%=hmd ❑ IIndgrd ❑ Na of Me`tss
New Service Amps / Vohs Ovenc=d ❑ Undgrd ❑ Na of Meyers
Number of Ftede s and Ampacity
Location and Nature of Proposed Electsici Work--
Comcie^or, o! lite (oiiawin¢ Pirie .rte 6 w-Ve—,: :e it �er a of rrir
No. of Recessed Fixtures
`Na of Ca -Suss (Paddle) Fans
�Tr-..rsforzers
[ret of Total
�� ❑ �1°P� ❑Other
Connection
Na of D ryers
a of WHeaters KW�
Heati� AppiLinas JW
I
°' of ha of
STEM Ballasu
Kai A
No. of Lighting Outlets
INa of Hot Tubs
IG= --=ors K'JA I
No. of Lighting Fi=res
ISivimming
Pooi Ab°vc ❑ Ln-
t-
❑
e. of :.mc?3 . L:;nung
d-11 ?rod.
Bare v Ulntu
No. of Rcccptade Outlets
No. of OD Burn=
IFER—E ALA -RIMS INa of Zones
Na of S%Yitches
No. of Gas Burners
No. of Dc,-- on and
I
Initiating Dcvicrs I
No. of Ranges
D
I Na of Air Conal. Total
Tons
INa of A1G.in0 Devic s
No. of Waste Disposcrs uW. cuup numucr i ions 1&W
Tocris:I I
Na of 5cll-:ontained
DetectionlAlerinQ Devices
No. of Dishwashers (SpacdAr=Heatin;
KW
�� ❑ �1°P� ❑Other
Connection
Na of D ryers
a of WHeaters KW�
Heati� AppiLinas JW
I
°' of ha of
STEM Ballasu
ecunry Systems:
Na of Devi= or Eauivaient
( Data Winn; I
Na of Derices or Eouivalert
No. Hydromassage Bathtubs
,Na of tylatorz Total HP
Tciccommutuamom Whin;
Na of Devices or Eaunaient
r+
Anaeh additional derail ifdairr4 or as remared by the Ins caw of lfirer.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the pedormanc Of dc=dall wane may istte uniesz
the lirasee provides proof of liability insarmac: indndmg "comoletd Operation" coverage or its substam cgtlivalcrL The
undersignd ca. reifies that mch coveragc is m fotc�, and las et Bled proof of same [odic permit issnmg omr-
CHECK ONE: R4SURANCE ❑ BOD ❑ 0'IT Q (5!?eaffY.)
Estimated Value of Fr Worts+ Is eV4. (Whet, rete fired by municipai policy.) (Expraaaa D=)
Work to Stat Inspections to be requeacd in accordant with NEC Rule 10, and mon completion.
I certify, under tepaels ofF39► information on lsrs app!mion is meuand campLez
FIRM NAME: ADT Security Services ..Or;.... Hol I is NH 03049 LIC N0- IS3C
Liccascc John S. Bassett Sigaaar �._ C NO.: Li33C
(Ifa*'=bie• enter "esanpt-irtt/te licsnsrmtarberlin�j
Address -
Bus Tel Na:J03 594-5900
A1L TeL No.: -603 594-5928
OWNER'S INSURANCE WAIVER: I am aware that the Lic msm does not have the tiabihrf instaaac =vc agc normally
required by law. By my siguatute below, I hereby waive this rquirc ML I am the (diene one) C1mvne ❑ o�vnc's ar'cnt.
Owner/Agent
Signature Telmhonc No. RERK7 FF F: S ��