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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .............. %/- '. %t b. W. E ......... 4ntL7-21.�-c ...............
has permission to perform ................. .................................
wiring in the building of ....... Lh.LA.I�A.g .... S ...... &.P>.6 ......
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at ..................7 .......Xte,,i........ 19 North Andover, Mass.
Fee... ic. No. ........ i....... ....... .. RICAL INSPECTOR
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Permit No.
• erartment ol—}ire �ervicej
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
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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 IN INK OR TYPE ALL INFORMATION) Date: October 29, 2010
City or Town of. North Andover To the Inspector of Wines:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 37 Village Green Drive
Owner or Tenant Village Green
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
Telephone No. (978)683-4101
Owner's Address c/o Property Management
of
Andover
-
Is this permit in conjunction with a building permit? .
Yes ❑
No 0
(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: Installation of (3) new light fixtures to
illuminate parking lot
Completion of the following table may be waived by the Inspector of Noires.
No..of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
SwimmingPool AboveEl In-
rnd. ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pum
Number
Tons
KW �
No. of Self -Contained
Totals
Detection/Alerting Devices
No. of Dishwashers
g S ace/Area Heating
p el KW
Municipal
Local ❑ Connection E:1 Other
No. of Dryers
Heating Appliances KW
Security ystems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Noires.
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 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 pen -nit issuing office.
CHECK ONE: INSURANCE x❑ BOND ❑ OTHER ❑ (Specify:)
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Crowe & Sons Electrical Corp.LIC. No.: 17168A
Licensee: James B. Crowe Signature LIC. NO.:
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: (978)453-6696
Address: 576 Middlesex Street, Lowell, MA 01851 Alt. Tel. No.: (978)251-8573
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS CO 001051
OWNER'S INSURANCE WAIVER: 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 El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $ 55.00