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9561
Date ..Y. — 0...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .... . . ............ .... ....................... . .............................
has permission to perform ......... ..........................
wiring in the building of ...................
. ...... aw zx.....9/1.............. North Andover, Mass.
I~ee ..................... Lic. No...T6 ............... . iL . . .... . .....
*EI�A� 1'�SP��I
Check#
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Cavi < -Lo rtweaith, of A assn chuseffS
Department of Fire Services
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BOARD OF FCRE PREVE�TfCtr! REGULA,TfC I`'u
Official Use Only
Permit No. 05- 2?/
Occupancy and Fee Checked
:ev. 9/05] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code ( C), 5 7 CMR 12.00
NT IN INK OR TYPE ALL INF RM TION) Date: � (' Il b
(PLEASE PRI p 1
City or Town of: Norte v-) cv-e 1- To the Inspector of Wires:
By this application the undersigned gives noticeI__ of his or her intention to pe orm the electrical work described below.
Location (Street & Number) �p �(a �) I C �� ( 1 yl
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Telephone No.
Yes ❑ No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Completion of the following table may be waived by the Inspector of Wires.
0 of Total
No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans
No. of Luminaire Outlets
No. of Luminaires
No. of Receptacle Outlets
No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
No. of Water
Heaters
f
No. of Hot Tubs
Above
Swimming Pool grnd. ❑
No. of Oil Burners
No. of Gas Burners
No. of Air Cond. Tons
eat Pump umber ons I'
Totals:
Space/Area Heating KW
Heating Appliances KW
No. of o. of
KW r:_ Ballasts
INo. Hydromassage Bathtubs
of Motors Total HP
Transformers KVA
Generators KVA
No. of Emergency Lighting
❑
BatteEy Units
FIRE ALARMS No. of Zones
o. of I}etection and
Initiating Devices
No. of Alerting Devices
No. of elf -Contained
Detection/Alertin Devices
unicipa ❑ Other
Local ❑ ('nnnecti n
Data Wiring:
No. of Devices or
Telecommunications
No. of Devices or
vl�
OTHER:
Attach additional detail if desired, 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 liabi ' insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coy rage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, under th pains and penalties o er'ury, tha the formation this application is true and complete.
FIRM N LIC. NO.:
lki
Licensee: ignatur LIC. NO.•
(If applic ent t " 'n t e nee ber ne.) Bus. Tel. No..
IN
1% aMOW
Addres . Alt. Tel. No.:
*Security
� S
*Security ystem Contractor License required for this work; if applicable, enter the license number here:
OWNER'S INSURANCE WAITER: 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.
Ownerl&gent Telephone No. PERMIT FEE: $
Signature
9
L
89u5
SAN-
Date3—.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..... <a.,. . . ............
has permission to perform 5, ... 4u.47`f I . . .
plumbing in the buildings of
at ...................................... North Andover, Mass.
Fee z: .". . . . Lie. No./>.–2- / 2—
........ ....
PLUMBING IN§f*MR
Check #
MASSACHUSETTS IM I IFORM APPLICATION FOR PERMIT TO DO PLUMBING
L -, .
MA. Date: ; Permit#
Building Location:_ (fiI�,� �c�U21 �� l I
Owners Name: _1�j�6 ) l * �r j
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New:" Alteration: ❑ Renovation:
FIXTURES
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•SUB BSMT.
BASEMENT
1sT FLOOR
4'" FLOOR
5T" FLOOR
6T" FLOOR
7T" FLOOR
8T" FLOOR
Plans Submitted: Yes n No
DEDICATED
SYSTEMS
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Installing Company Name: Check One Only Certificate # l
Corporation
Address:W&& City/Town: 1441tate:
�e �. ,� r/��� El Partnership
Business Tel: �f Fax:
❑ Firm/Company
Name of Licensed Plumber: ') )�r FF 1:[T4 , ; �-z „i
INSURANCE COVERAGE: _
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑
If you have checked Yes, please indicate the .type of coverage by checking the appropriate box below.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Si nature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted (or entere
Knowledge and that all plumbing work and installations performed under the pe
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142
By_
Title
Type of License:
License
this application are true and accurate to the best of my
orthisfapplication will be in compliance with all
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