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N2 r V Date./� /..!
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NORTH 1
TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
,S$ACMUSE•�
This certifies that ........V.!.....`.0... e..........1 .(f.�A..............................
has permission to perform .........TI .,.....)Pkw.�....................................
wiring in the building of �. Z
at!....... ... ...........�.....!.0.... ...........................� ` . . , SA A North-Andover,.1.'.
.Mass /7
LiNFee.. c. o �
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+ EL ICAL INSPECTOR
Check # l 1
WHITE:Applicant CANARY: Building Dept. PINK:Treasurer
t�o»tmonwaallfi o�/Y/ad9ac%c�vll� Oflicicl USC Only �� `•;
c� �] Permit No.
k JJ¢parintonl o�..}ira �¢rvica�
Occupancy and Fee Checked
`= BOARD OF FIRE PREVENTION REGULATIONS (Rcv. 11/991 (leave blink)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perlornted in accordance with the Massachusetts lilectrical Code(i` ), 52 C�1R 13.00
(PLEASE PRIrVT IN INK OR TYPEALL //V/:'Q AL-1 Orv) Date: �. � f!�
/� 4
City or 'I'o��'n of: �'1 Uh G?r'Pik To the Inspector oJbPiles:
[3v this application the undersigned gives none•of I or her int 11 to per ornn; the elecn-ical work described below.
Location (S(reet R Number) I QY G
Owner or Tenant Z.Z-(� Telephone No.
Owner's Address CA, D
Is this permit in conjunction Nvith a building permi t? Yes ❑ No ❑ (Cheese Appropriate Box)
Purpose of Building, Utility Authorization No.
Existing Scrvice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters .
New Service Amps / Volts OwCrhCnd ❑ Undgrd ❑ No. of Meters:
Number of Feeders and Ampacity
L cation and t ture of Proposed Electrical Work:-lei J" C '
Cl. i sh
Completion of die following table inav be n•aired bw the lns•cctor o('1 vires.
t No. of Recessed Fixtures • ilo.of Ceil.-Susp.(PNo. of Total
Fans rraiisformers KVA
No. of Lighting Outlets No.of blot Tubs Generators I\VA
Above In- t o.o Emergency Lighting
No. of Lighting Fixtures Swimming Pool ornd. grnd. ❑ Battery Units
No. of Receptacle Outlets No.of Oil Burners FIRE ALAILI•IS No.of Zones
of Detection
No. of Switches No.of Gas Burners Total t 0. InitiatingD and ,
Devices
No. of Ranges No.of Air Cond. Tons No. of Alerting Devices
Flcat}'ump t_umber_ 'Tons K t_ o.of Self-Contained
No. of Waste Disposers Totals: - - - Detection/Alerting Devices
No. of Dishwashers g S ace/Arca Heating KW Local ❑ t luntcipal ❑ Other
P Connection
No. of Dryerati:s Hcating,Appliances KSecurity Systems:
No.of Devices or Equivalent
No. of`Vater KWNo. of No. of Data Wiring:
ng:
Sins Ballasts No.of Devices or Equivalent
No.Hvdrotnassaoe Bathtubs No.of ilotors Total IIP 'Telecommunications Wiring:
b l lo.of Devices or Equivalent
OTHER:
dttach additional derail if desired, oras required by the Inspector of;vires.
INSUR-2UNCE 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
undersioned certifies that suchciv age is iii Circe,and has exhibited proof of same to the permit issuing office.
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CHECK ONE: iN`SURANCE BOND [I OTHER [I (Specify:) -0V
(Expiration Date)
Estimated Value of Electrical Work:' (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NMEC Rule 10,and upon completion.
I certij•, tinder the/rains ntnl penalties of perjury,that the information on this application is trite and complete.
FlIL�I NAi\IE: V 1--046 4EL.AE74'-7_zeA .�H-"- LIC.No.: c? 3
Licensee•An r/fon y P b EL 6+10 • Signntur•e� _ _y L1 C.NO.: J76
(If appl, Ill enter '•e.c nip("in the license rrruuber line.) Bim.Tel.No.-97P-09_4 S
Address:rQ 'nex F(•k Tel.No.:27Z J61 5Pd�4
ON-'NER'S INSUl""ANCE NVAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. E3\ my signature below, I hereby waive this requirement. I an,the(check onc) ❑ owner ❑ owner's ag'en't.
Owner/Agent FPj_-Rj1f1TTTE:
Signature 'Telephone No.