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HomeMy WebLinkAboutElectrical Permit � � �IjC �OU11IiIIllIUE&IfI� Af ��SS&C�US2�B , .. perm�i Nou�c=_uso p�, � �cpartincnt nf.�u6ltc Bafctp : � oceu �-� P�ry 6 Foe Checkod BOARD OF FlRE PAEVENTION HEGULA7(ONS 52T CMft 12:00 . a�0 Paava bls�k) APPLICATION FOR PERMlT TO PERFORM ELECTRICAL, �`yn�',ORK All work to be perlormed In accordance wtlh Ihe Massachusalls Elactrfcal Code, 527 CMR Z;p� (PLEASE PRINT IN INK OR TYPE AlL INFOR�r1ATION) � Date / �3 99 Clly or Town oL. . S' �9Rr+�o L/�'� � To the Inspec�or o( W�raa: � The udersigned epplies (or a permil to perform Ihe alectrlcai work tlescrlbed below. � Loca�lon (Street 6 Number) �� �`9p�- �R� � vAG S- ,C ' ' Owner or Tenant /d �� �' i N'K Na � - . Owner's nddress ^ ' 99 . Is tliis pennll In eonJuncUon wlth g Ouliding permlL Yes ❑ No ❑ . (Che . Appfopflale Box) . Purpose ol Building Utility Aulhorl:alio � Ezisting Sarvice �_Amps �� 2>d Volts Overhead� undgrnd ❑ Nq; ol Meters ..�[_ New Service Amps Ji Voits Overhead ❑ UnCgrrd ❑ No. o( Melers � Num6er ol Feeders and Ampacity �/ � / LocaUon and NaWre ol Proposed Electrlcal Work Ttis�t �r ��0 V �5��'i6.������.e�bp-�� A�{.,/��A,e� � No. ol llphUnp Ou�Ia1a No. ol Hol 7ubs . No. o(Trans:armara To�e! - . • FCV� Na. of Uqhilnp Fialurea Swlmmin� Pool AOove In. � � � � ��— �� .. gmd. ❑ gmC. ❑ Generabn KVA � . No.o( Emerper.ry Llphlinp Na. of Recsplacie OuUau No. o( OII 8urnera 8anary Uniu No. ot Swildi Ou11a1s No. ol Gas Burnen . FIFE A:.inMS No. o( Zcnea - No. ol Renzea No. ol Alr CanC. Tolal No. a( Dalecdcn anG ' , , tona Initlelln; �avicas Na. of �Isposala No.of Heat Ta�al Tatal . ' ; Pumpa Tons KW Na. o( SounGlnq Oevlcen No. al Satf Containua ' No. ol Olsnwashera Space/P,lea Heaiing KW OetqcUoNSuunClnp Oevlcae � Na. of O�yart Heatlnp Davlcef KW Locai �������•8� �Ot�et ❑ Canneetlen � No. ol No. ol Low Volta�a , ' No.of Wa�ar Hsatan KW S�qna Ballasln Wlrinq ' i (((v���\ . v� No. NyOm blasaags TuCa Na. ol Molon Tolal FIP 7/ . � ( • � 1 � OThtER: � J� � . , . l � u�SURANCe COVERAGE: Purou�nt lo the requlramania oi MaeaacRusatta penerol Lawa ' - � � 1 nave � <vrnnl Uabilily Inauranc� Poll<y Including Camploied Opere�icna Co�sraqa ar Ua m�a�antlel eGulvnlen6 YES O NO ❑ � ��� I�avs suOmitleC valld proof o1 aam� Io Ns 011iee. YES ❑ NO ❑ 11 yau heve <naekaE YES, pleaae InGlCatu l.h's t 3e ol/eavarape by � � c�ecking the appropr(au box. L�M a� J�� / /9 9 �'"�-i INSUFiANCE O BONO ❑ OTHER �(Pleasa Speclly) (F�plraUon Oata) , .`.. EstLneleE Value a( Eleeldeal Work S �� ��� f, � , y / -�y F.Inal : ... Work�o Siart ' . ..... . Inspectlon Data Aaquesied: Reupn . .. . . .. . . - `�... Slqnea uneer Ihe Penald�a af p ry: D �/���� c ' � LIC. NO. /13 S � 4 FIRM NAME ' �' NR 27J-�oL � � � - Ucensee /�RR""'c t �RA Slpnaww LIC.NO.�------�'� �^� Soi 775� 36� Bue.Tal. No. Address All. el.No. � �' OVVNER'S INSURANCE WAIVEfl: I am ewata It+a! lha LlCenzea doea noP�ave �PPlnsurnnce Covara�a oqUa auOatanllal o���a�O�lQu i~ � �� qulre� Ey Masaaehwetla Gananl Lswa, and thal my s�G�a��re on We etmll a Ilcalbn walvea lhia fe uiremenl• Owne! , � �� (Pleaae c�eck one) � .. . .. . . \ Telep�ons No. PERMIT FEE 5 .'M._ \ (SlanaWn ol Owox m Aq�nq