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Date ...... 2 -......2� .-.....0 0
............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............
lel ..... ..LT ......................
has permission to perform ......
.................................
wiring in the building of ..... ........ /*
3-5-0 el-wtel< 5/ -
at ............................................................................... . North Andover, Mass.
/5375
Fee,ME '77'= .... Lic. No. ................. .....
ELECTRICAL INSPECTOR
Check #
8004
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 01 - � O
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) ; 50 C t c, C K SA (e
Owner or Tenant C(0S0-�er PO'SS I, Telephone No. A1$-19,4 C1 00
Owner's Address Iso C \Nf 1" SA rC k 4J A `fir stir V�Cl-
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz)
Purpose of Building 1 S0 � JCA k An Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
R New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity ` - L1 bU a.. e
VLocation` and Nature ofProposedWork: N r�� \\ C, V\ c � �� C,V - `L (Z L, ,J c �t
(Iu )-6 � J "C,.V%t \ G .� .�.r Via. c. j '•'`•�. ch
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Cefl.-Susp. (Paddle) Fans
o' of Total
Transformers l KVA 1�
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires y $
Swimming Pool Above ❑ In-
rnd. nd.
o. o Emergency Lighting ` b
BatteryUnits
No. of Receptacle Outlets j 3
No. of Oil Burners
FIRE ALARMS
No. of Zones 2..
No. of Switches
No. of Gas Burners
and
No. In itiatinDevices
In3
Ranges
No. of Ran
Total
No. of Air Cond. Tons
1
No. of Alerting Devices 10
No. of Waste Disposers
Heat Pump
Totals:
Number ITons JKW
No. of Self -Contained
Detection/Alerting Devices
I I I
No. of Dishwashers
Space/Area Heating KW
Localunicipal ElOther
Connection
No. of Dryers
Heating Appliances KW
Sectio. Systems: or Equivalent
No. of Water
Heaters KW
No. of o. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications
of evices Equivalent
C ,
OTHER: L� c... 2 e ti • �+ c c 14114y\. CA- Q
A Hach additional detail if desirett or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this appli ' n is true and complete.
FIRM NAME:1 l rn a c e `r c t• c T C. LIC. NO.:
Licensee: may, Npt y 14`1 un E Signatu a 449i
LIC. NO.:
(If applicable, enter "exempt" in the license number ling.) Bus. Tel. No.. (I -)-K -3 , 1 5 71
Address: JCC, I) �c_✓ z �� 11 �M Z�— Alt. Tel. No.: silk - I'l0 -1(00
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Sa ety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $
Rkbq., 6--/� �)�
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