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999
IiORTM
�-6 0 TOWN OF NORTH ANDOVER;
PERMIT FOR WIRING
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This certifies thatMR c 12, �N C
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has permission to perform ....:/.. ....� � +✓C..t.................:
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wiring in the building of...1�....... ..�........... �� ... E`:�......::...
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' orth Andover,Mass.
Fee 5P............. Lic.
jELECTRICAL INSPECTOR
WHITE:Applicant CANARY.Building Dept. PINK:Treasure
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l411t (Ell111uwuwtultli Vf Mussudjusttts Office Use Only'
Uepartntent..of t ablic Safely g
Permit No.
'BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Occupancy & Fee Checked..y.��
3/90 (leave blank)
j' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK' .
All work to be performed in accordance with the Mas�achuwqus Electrical Code,S27 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
City-or Town of N o(L" �,J 3�d VF I To.the Inspector of Wires:
The undersigned applies for a permit In perform the electrical work descnhed helow.
Location (Street& Number) m A5 S -E C E C
PO LC LN7 g 3 bX r6) L-D
.Owner or Tenant., bn o o lY/ U ti'T jt.11._. �r(j n!l c
Owners Address b k�1 lA--( D /Z Dn_�(o / P6 L '�l
Is this permit in conjunction with a huiklin, pe0nit: Yos ❑ No (_I (Check Appropriate Box) .
Purpose of BuildingL
Authorization No. .r7 f7
Existing$ervice' Amps� �---- Volts Overhead 1:1 No.of Meters
New Service _�_O Amps 1� J 9-y 0 Volts Overhead Undgrd ❑ No.of Meters
j. Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 0/?-/3"/11 C A-C_
TOTAL .
No. of lighting Outlets No. of Hot Tubs No, of Transformers KVA
Above In-
No.of Lighting Fixtures Swimmin Pool rnd, ❑ End, ❑ Generators KVA'
No.of Receptacle Gutters No, oNo. o Emergency Lighting
nil Brrner� Ratter Units
No, of Switch Outlets No-of Gas Burners FIRE ALARMS No.of Zones
Total No. of Detection and
No. of Ranges No, of Air Conditioners Tons
Heat Tota Tota Initiating Devices
No. of DisposalsNo.of Sounding Devices.
j.
No. of Penn hs funs KW No. of Self Contained
No.of Dishwashers Detection/Sounding Devices. e
fj S ar_e/Ales Hearin KW Municipal
No. of D ers Heatin g Devices KW Local❑* Connection ❑Other
No.chl No. of Low Voltage
No.of Water Heaters KW Signs Ballasts Wiring
No. Hydro Massage Tubs No of Motors Total HP
l OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Muss ichusties General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑NO❑!.have submitted valid proof
of same to this office.YES O NO
If you have Checked YES, please indicate tine type of coverage by Checking the appropriate box.
INSURANCE BOND ❑ OTHER❑ (Please Specify)
Estimated Value of Electrical Work $._
(Expiration Date)
I
Work to Start Inspeclion 11ite Rerluesled: RolighPinal
Signed under the penalties of perjury: � — ---
FIRM NAME 6rl E` �Z�C oh r ti
C—LIC. NO.
Licensee "-r-HO k) A'1-'6 a 4
—Signature
LIC. NO. S3 7 5
Address �n x}V0_o f D / 1l f72 C .- - 5-09
— - Bus. Tel. No. -374--ST77
Alt. Tel. No.
.OWNER'S;INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
.General Laws,and that my signalure on this permit application waives this requirement., Owner Agent (Please check one)
_' ' ba
-------- Telephone No.__.----._..____.....___ PERMIT FEE$So
(Signature of Owner or Agent)