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Date..... ......
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NORTH
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TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
SS CHUS
This certifies that .;.,,.:............. ...
.. ........ .........
has permission to perf
wiring in the building of,.,. ..... .............. .. ........
at..... 71/ .............
................. ,North Andover,Mass.
..... .............
Fee d....... Lic.No./ ...........................
ELECTRICALINSPECTOR
Check 'V
5187
Commonwealth of Massachusetts oMfficial Use Only
r : /
/ Permit No.
- d Department of Fire Services
'l fir; Occupancy an*ecked /Ili
BOARD OF FIREPREVENTION REGULATIONS [Rev. 11/ 9]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL o�r
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 17.00
(PLEASE PRINT IN INK OR TYPE`�LLNFORMATION) Date: $ t7
City or Town of: NoR'TH'IANP61VOK 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) 5-51 'Tt'.t'R N Pt KE SI-RE45T Ck-re . /(q-
Owner or Tenant SAW F(vE CeMl SAy11y6Y BANK Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.-of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion o the following table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
t Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
AboveIn- o.oEmergency Lighting
ti No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No. In Detection and
nitiatin Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
r, P Totals: I. I I Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal ❑ Other
P g Connection
j No.of Dryers Heating Appliances KW Secute
rio.o sevices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassane Bathtubs No.of Motors Total HP Telecommunications Wiring:
b No.of Devices or Eq uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: ASAP Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify,under the pains and penalties of perjury,that the information on this application,is true and complete.
FIRM NAME: N sfANT sI(rNA t.- & Ai-ARM Cv. I N C. LIC.NO.: IN-1c,
Licensee: OA K w y\/r,, SC U'rT- Signature LIC.NO._ C.,
(If applicable, me "ex/e�tpt"in the lice se tJ�umber line.) Bus.Tel.No.:� `/070-
Address: D A( q�l(Q a �yei� & Lem YA 01910 Alt.Tel.No.:
OWNER'S INSURAN 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 atn the(check one)❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE: $ j 2 S°°
Signature Telephone No.