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HomeMy WebLinkAboutMiscellaneous - 53 VILLAGE GREEN DRIVE 4/30/2018Date .... ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... .......................... ................................ has permission to perform ...... ......... aL "L�� .............. .............................................. wiring in the building of ........ . ...... . ..... C/ ... at ... ......... .......... North Andover, Mass. Fee .................... Lic. No.. .. i 1 ......... ELECTRICALINSP CTW Check # 7693 U I i The Commonwealth of Massachusetts Office Use Only GI Permit No. A 1 Department of Public Safety Occupancy & Fee Checked =/ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) PPLICATI 0 N FOR PER M IT TO PERFOR ELECTRIC AL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date September 21 � 9n07 North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 52 Vill agP_ GreP Drive OwnerorTenant_Property Management of Andov91" Owner's Address P. -0, Box 488 Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Residential 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 _' L i gh t i n g- in bo i ler r o o m_ No. of Lighting Outlets g g No. of Hot Tubs Total No. of Transformers KVq No. of Lighting Fixtures Above In Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units No. of Switch Outlets No. of Gas burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal Local ❑ Connection [:]Other No. of Ranges Total No. of Air Cond. tons No. of Disposals Heat Total Total No. of Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of ,Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. I have submitted valid proof of same to this office. YES © NO ❑. If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE R BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ Work to Start Signed under the penalties of perjury: FIRM NAME CROWE & SONS Inspection Date Required: Rough ELECTRICAL CO Licensee JAMES B. CROWE Signature YES ® NO ❑ (Expiration Date) Final LIC. NO.1716 8A LIC. 10.17168A Address 576 MIDDLESEX STREET, LOWELL MA 01851 Bus.TeLNo.�778)453 �69�— Alt. Tel. No.(978)2-5i-8b/3 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 signature on this permit application waives this requirement. Owner ❑ Agent ❑ (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) Date... ........... ...... . NORTH 1TOWN OF NORTH ANDOVER OyR"to ,eti�O ;, PERMIT FOR GAS INSTALLATION This certifies that .. t : .......... ....................... l has permission for gas installation .................. in the buildings of .. ..... .. - :..................... at ..:.:� ..�... �'.:..`�`� �- .:...`. ! 1 -North Andover, Mass. Fee. :... Lic. No. ........ . C� ~ GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NQ ANbOyC-12 , Mass. City, Town Building /'� AT: Location 53 �/ w't'r' C -Few New ❑ Renovation ❑ Plans Submitted Yes ❑ No% DateX 2-3 z Permit # Owner' s� DV NamJL jL'j4U_(•� Type of Occupancy: &00 D is placement (Print or Type) '�j A Installing Company Name ► ►�1 �LE� j Address NAl ,230 sit Ib� �Y Y Check One: ❑ Corp. ❑ Partnership _ U9-11�rm/ Company Business Telephone3 - /�� Name of i�� sed Plumber or sfitter la l Am 1ZIVDiS Certificate F(1QI�A lith I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of 0-ner(Agent I have a current liability insurance policy to include completed operations coverage. I!?" By Title City; Town APPROVED (OFFICE USE ONLY) it 140QQc A WAQQCN INl: 1QAo TYPE LICENSE: 0--f-lumber ❑ Gasfitter ❑ M ter Journeyman f Signature of Licensed Plumber or Gasfitter License Number z A O z 9 D 0 w w i a E 2 z Q � � ®m rn z 0 0 0 N Z z , O O z A O z 9 D 0 w w i a E 2 z Q � � ®m W CL U) z 2] rn z 0 0 W CL U) z 2] rn z 0 z , W CL U) z 2]