HomeMy WebLinkAboutMiscellaneous - 56 VILLAGE GREEN DRIVE 4/30/2018—__
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Date ..& - z- 7.- / 'L
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... (�.. �? .. -. �. 77,
has permission to perform ......: C7V 41e.
wiring in the building of .. G .�5 .:.i. '"!> p? .............
at..,5� .�41/� j. ��?. <...... , X orth Andover, Mass.
Fez ..°—p-Lic. No. f %l?7! ....../�/� .l.p . .. .
ELECTRICAL INSPECTOR
Check # 7Z6 77
10916
Coinmonwea& o/ Xa33acL,tt3
oUePartment of —7ire Seruicm
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only '
PermitNo.
Occupancy and Fee Checked
[Rev. 1/071 (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the. Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT W INK OR TYPE ALL EWORMATIOA9 Dater �2 cDQ. } act
City or Town of QC-NAL)uec- 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) nQ IJl' ( t'i G ('��r',, -1 U c
Owner or Tenant
Telephone
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No. ® (Check Appropriate Box)
Purpose of Bnitding I t?'�i G�N,6�t� �C�. Utility Authorization No.
.is .gSe..;ce Amts ! VcI� 0.4.Gcad ❑ Urdgrd❑ ifo: vfimeters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters.
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:��-
Com letion of the following table may be waived by the Inspector of YYires.
No.:of Recessed LuminairesNo:
of Ceil.-Snsp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets .
No. of Hot Tubs
Generators KVO'
No. of Luminaires
Above In-
Swimming Pooi_gy❑ nd. ❑
nd.
No. of Emergency Lighting
Batte Units .
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
. of Datinooc vid
Initiatin Devices
No. of Ranges
Totnt
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
�P
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alertin Devices
No, of Dishwashers
Space/Area Heating KW
Local ❑ Municipal Connection ❑ Other
No. of Dryers
ry
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No.•of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
1vQ of neE:ces u_ E t�; •Wert
OTHER:
Attach additional detail y aesirea, or as requires oy erre ,u alir. .. i .. •
Estimated Value of EIectrical 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 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: INTSURANCE..fc] BOND ❑ . OTHER ❑' (Specify:)
Y cerkfy, under thepains and penalties ofperwry, that the information on this applicatzon is true and complete
FIRM Crowe & Sons Electrical -Corp. LIC:NO. i7-f68A
James B. Crowe C�-t� LIC. NO.: A
Licensee: Signator 4_53-669,
(If applicable enter `exempt" in the license number line.) . - Bus. Tel. No.:
_Address: 576 Middlesex Street, Zowe11, Ma 01851 Alt. Tel. No.: -669'
*Per M.G.L. c. 147, s. 57-61, security work requires Department ofPublic Safety "S" License: Lic. No. SS CO 0010 51
OWNER'S INSURANCE WAIVER: I am aware that the Licenseedoesnot hm�e the liability.insurance coverage normally
.required by law. By my -signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ o'"mer's.a ent.
Owner/Agent PERM, IT FEE:
Signature Telephone No.