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HomeMy WebLinkAboutElectrical Permit � - .. ./ . . •, , , + �, _.. 0t1iu Us� � LIiL (r::,�ttnati�neaith af +�i�1���hu�Lits �,,;� N,. . � ' �cpartmcnt a� �JuBtdc �afctq t p�eupan�y 6 Fae Cnacicsd � 4 BOARD OF FlRE PREVENTION REGULATIONS 527 CMH iZ00 5/92 (1e,�. blaak) � � APWLICATION FOR PERMIT TO PERFORM ELECT ICAL W0 R i a ,„ All work to be peitormed in accwdanee with tbe Massachusetts pectrlaal Code. 527 CMR 72•00 �� w �P��SE PRINT IN INi� ��F ALL INFORMATION) � ' jw Clty or Town ot � T� ��,q{�cto W(re, l�=�] u I �° The u,�erstgned applies tor a�aermit to pertorm ehs electrical wor�dasuib elow. � � T4 Loca;� rt(Street a. Numd*�' ,;�3 f��Di..�/ �"- �Yc' ,� � - 8 19 i �'. �11.� . (3��c��2_. �/ �e�. Ow�q�Or;Tenant _ � � e /,.�,J I '� 4;� Owner7s Address �, �/I��DY`p�J �— . - - , i ' 4' Is thisjjpermit in conjunctton with m buiiding permit: Yes � No ❑ (Check ApproprlatB BOx) � � '. Purpos"e ot Building /�u/l=LLd d-!G ,� Utitity AuthorizaUon No. I , $ Exlsting Service Amps J Volts Overhe;id ❑ Undpmd ❑ No. o(Maters ' �.W- New.�ce Amps _! Volts Overhead � Undgmd ❑ � No, of Meten � I � w Numbe►of Feeders and Ampacity ' i str� LocatlaA and Nature of Praposed Electrical Work ��C� i v l7G'/��c:K��E rU..i� f"Ti�Wlc �(sfi�� F ��O ..-: Na d L.tqMlnp Ouaata � No. W Ho�7tibs 7bta1 :.': . a No.W ltansformen �A� � . � '� �� Ho.of UphUnq qxwrp ...Swimminq Poo1 9�+�� gmd. ❑ 6�narators KVA I� ` " 1 �:: No.W.ii,ee 1 W.d Em�rqenry UphWp . ' a tEUele Outleb �. No.ol Oil Bumara . Batt�ry Units � ry � . No ot SMiitehes No, of Gu Burnars � FlRE ALARMS Na d Zom� ��� No Of Rflh p � No. 01 Air Contl. To� � �.ot ONeeNon an0 �� �� :� s.!'Q r tona � Wtladnp'D�vitas . . I. �' '`� � No ot ClsPosal� � No.of Haat Tonl Toul '� � , � a y Pumps Tons KW Na W Sow�dlny Owieu �I .�.�.� : � No.of Sall Con�ainW I r �.: No.of O(shwa:hen .. . SPacdAna Hasting � .Kyy Da��dloNSwndfnp Dwie�s. � I °' � � No.o(Drypn�. Ha�tiny Oavieaa �Kyy .. �� M�^�Ptl � � ... , - ❑ Connaetbn QOtMf i . .;, , . No. a No.a tow Witap� � � ; � �r r.._ ,.P�ar.Heaten .. KV1! .. .. Signs . .. Ballazu.. . . . . yyy�� � ... No W yy y �^� No. Hydro;Massage Tubs No. ol Moton Total HP Seeurity System � !c �. OTHEA: �.j: �� � INSU rCE COVERAGE Pursuant to th�mquiremen[s ot•Mazsachusstb yaneral laws � �'1 �1 haw� nt Llabtlity Insurane� Poliry v�cluaing Com Iatad OPerations Cowraq� w its auDzmntial puivabn4 VE$ � NO �� ���sUb�.�IttYtl valid :jv�, " prool 01 aam� ro ths OHiee. YES NO p �1 yQu hav�eh�ebtl YES, pl�as� IMiut� tN�typ�of eov�ra .1 j i NSU �CE�ifro80ND O OTHEA G (Plsasa SPaciy) ' � /-2�3/�f j 9f � '� �.- /T ' (ExPkatbn Datr "� ' �� � �1'ROPRIAIF BOX: I have Lbrker's Compensation Insuranae t. � I have no F�ploytes � ��"' Esumated;Value o1 Elactrical Work S � � ' �� Work to Slart_ �— 7 — `f'y �m �� � 3 y InsPection Da�e Requented: Pi�u9� Fnal .���/� .. {{ Siqn�d unpar the e altias ol perJury: � 1},�,5 flRM NAfTi'E e� H.lZYC�'(.� 7`3'L��� .. . .�. IJC. NO./� 77�93� „� s)�t��i�� Lfc�ns�� ` � fi�� S� �{T6rG�'6G:.� Signatura / c.0+._ r ..� 4" � LIC. NO. i � " �j AdWoss�/�U� '�J4' r/ GL ElT��'U6(�C� GLeL� O..ZCjL eua. 7�1. No. _ f/1a-�'GZ5 — � -+� ! °OWNER• NL Til. No. S�INSUAANCE WAIVER: I am awue that Ins Licensae aoes not nava ;ns insunnea eov�raqe or ns�:upzqm�al ponra��n�N'n � ; �Q (P4as�'M���usattz General Lawa. anC ��at rtry signature on t�is permit apPlieation waiws tMis raQuinm�nL Owno /1p�/q ch�ck onel '� � � � ��.s�� _ . .. . s