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HomeMy WebLinkAboutE-07-970C mmonwealthofMassachusetts Offic�ialUseOaly �7o Department of Fire Services Permit No. C, rC� v Occu enc and Fee CheckedF FIRE PREVENTION REGULATIONS (Rev 1/99] eaeblz.•tkN 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 INFO�j'�A11ON) Date: -,41—a2 3 '-0 7City or Town of: Q_ rmo�/1'h To the Inspector of Wires: By this application the undersigned gives nc.C% of his or her intention to perform the electrical work described below. Location (Street& Number) c29 NIA Map -- - Parcel Owner or Tenant Fltim )}c {d e Telephone No. Owner'sAddress Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /00 Amps ?t'/? Volts Overhead Q Undgrd ❑ No. of Meters New Service /0 6 Amps / /Z Volts Overhead © Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: lkey ( tie Enr lerion of the ollowin table im be waived by the lni tctor of Wires. O. o Total No. of Recessed Fixtures No. of Cell.-Susp. (Paddle) Fans ITriansformeris KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA Above In. N-5.0YErnergency Eighting No. of Lighting Fixtures Swimming Pool rnd. grnd. ❑ BatterY Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Gas Burners o. o erect on an No. of Switches initiating Devices No. of Ranges No. of Air Cond. Tons Nal o. of Alerting Devices No. of Waste Disposers le It um er ons Detec0.0 tion/Alcrtin Devices No. of Dishwashers Space/Area Iieatlug KW Local ❑ C' '; con ❑ Other Beating Appliances Kir Security Systems: No. of Dryers No. of Devices or E ulvalent 0.0 ater KW 0.0 o• o Data Wiring: Ballasts s or E utvalent Heaters Signs aass No. of Device Telecommunications Ir g: No. Hydromassage Bathtubs JNo. of Motors Total HP No. of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Aupector of Wires. 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: INSURANCE, BOND ❑ OTHER ❑ (Specify:) (Expiration D=) Estimated Value of Electrical Work: {�_ (When required by municipal policy.) Work to Start: -z/—;?3—P7 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certyy, tinder the pains and penalties o perjury, that the infonnation orLthif application is tare and complete. 12 FIRM NAb1E: / ! LIC. DiO.: �� Licensee: % ,s n , ,a e S(11) %�% Signature ((f applicable, ewer "exempt" lit the license numbrr (ine.) Bus. Tel. No.: Address: ! t Alt. Tel. No. OWN'ER'SSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally I required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. r%w"PrtA Pent I PRRMIT FF.F.: t _ commonwealth of MassachusettsEPermItNo. frcialUse only Department of Fire Services 2007 Fee Checked A OF FIRE PREVENTION REGULATIONSveblank :,:c nGGT By. N FOR PERMITTO PERFORM ELECTRICAL WORK All work to be perforped in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TTON) Date: -Z -o7 3 "0 % City or Town of: (I Q Yoil To the Inspector of Wires: By this application the undersigned gives nuC% of his or her intention to perform the electrical work described below. Location (Street & Ntunber) c� q N i a a 611 1) hl 1 Ma P Parcel Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building b U�e If}i it aUtility Authorization No. Existing Service lob Amps ?1 2 Volts Overhead Q Undgrd ❑ No. of Meters erya ice /ab Amps /fid /ZED Volts Overhead ® Undgrd ❑ No. of Meters _( _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rev (1A ? Q f1 P ► � S t 4 l A,°Wzon table' rs KVA FIRE ALARMS INo. of Zones of Alerting Devices municipal,. Local ❑ r„n",ftm„ ❑ Other Attach cddrtiona( detail V desired, or as required by the bupector of Wires. v 1� INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licenser: provides proof of liability insurance including "completed operadon" 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. CHECKONE: INSURANCBJ5� BOND ❑ OTHER ❑ (Specify:) (Expiration Dare) Estimated Value of Electrical Work: ySrytn (When required by municipal policy.) t Work to Start: IY-,73 `277 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certo, tinder the pains and penalties o perjury, that the informationo th(s application is trite and complete. u FIRM NAME: LIC. NO.- a (� Licensee:Signature LIC. NO.: (If opplicable, enter "erenipt" ht the license numbu' line.) Bus. Tel. No.*l Address: Alt. Tel. No.: OWNER'S SURANCE WAIVER: I am aware that the Mcensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent n.,,...r/Agent _ . .. PERMIT FF.F.!.£ .i,r, No. of Recessed Fixtures No. of Cell.-Susp. (Paddle) Fans No. of Lighting Outlets No, of Hot Tubs No. of Lighting Fixtures Swimming Pool rode ❑ n- ❑ No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners !n No. of Ranges Total No. of Air Cond. Tons N No. of Waste Disposers eat ump um er ons Totals: No. of Dishwashers Space/Area Heatlog KW ( No. of Dryers Heating Appliances KW do. o ater N Heaters KW o. o o. of Signs Ballasts N Cs No. Ilydromassage Bathtubs No. of Motors Total HP table' rs KVA FIRE ALARMS INo. of Zones of Alerting Devices municipal,. Local ❑ r„n",ftm„ ❑ Other Attach cddrtiona( detail V desired, or as required by the bupector of Wires. v 1� INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licenser: provides proof of liability insurance including "completed operadon" 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. CHECKONE: INSURANCBJ5� BOND ❑ OTHER ❑ (Specify:) (Expiration Dare) Estimated Value of Electrical Work: ySrytn (When required by municipal policy.) t Work to Start: IY-,73 `277 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certo, tinder the pains and penalties o perjury, that the informationo th(s application is trite and complete. u FIRM NAME: LIC. NO.- a (� Licensee:Signature LIC. NO.: (If opplicable, enter "erenipt" ht the license numbu' line.) Bus. Tel. No.*l Address: Alt. Tel. No.: OWNER'S SURANCE WAIVER: I am aware that the Mcensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent n.,,...r/Agent _ . .. PERMIT FF.F.!.£ .i,r, • • I V E ommonwealth of Massachusetts Ofco firc�l^alUse Only /) Department of FireServlces Permit No. r ^r)� q7v 1 2007 Occu aac end Fee Checked V J� BOA D OF FIRE PREVENTION REGULATIONS [Rev. 11anc eFeblxnlc i DEPT. By: N 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 INFO ATTON) Date: --Y—n? 3 '-0 7 City or Town of: _40 rmOt� To the Inspector of Wires: By this application the undersigned gives not: • : of his or her intention to perform the electrical work described below. Location (Street & Number) c29 N 1 O Ni Cf AI P D x111 Map Parcel OwnerorTenant FJOPtA(f, )ATelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes R1 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /00 Amps 2W 2 Volts Overhead Q Undgrd ❑ No. of Meters N aw , ervice �_ Amps / f2 Volts Overhead ® Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: — -- No. of Recessed Fixtures No. oPLig g Outlets Lighting No. of Lighting Fixtures Na. of Cell.-5usp. (Paddle) Fans Na, of Hot Tubs ove n'0. Swimming Pool rnd.grind. Transformers KVA Generators KVO' o mergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. o election an No. of Switches No, of Gas Burners lnitiatin Devices No. of Ranges No. of Air Conti. Tons No. of Alerting Devices No. of Waste Disposers eatPum um er ons _ Totals: _ 0.0 e - onto e Detection/Alertin Devices Space/Area Heating KW Local ❑ Connect al on Other No. of Dishwashers Heating Appliances pliances KW ecunty ystems: No. of Devices or E uivalent No. of Dryers 0.0 ater K� o. o o. o ' ct.,.,. Ballasts Data Wiring: I No. of Devices or Equivalent INo of Motors Total HP ' �`"No. of Devices or Equivalent No. I�ydromassage Bathtubs OTHER: Attach additional detail if desired or as required by the Inspector of Wires. 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. CIIECKONE: INSURANCE, BOND ❑ OTHER ❑ (Specify:) (Expiration Dare) Estimated Value of Electrical Work �S 7t�f� _ (When required by municipal policy. Work to Start.' ,73 ZJ% inspections to be requested in accordance with MEC Rule 10, and upon completion. • I certify, tinder the pains and penalties of perjury, that the inforination o t)tis application is true and complete. FIRM NAME: LIC. NO.: e l Licensee:rl l t y¢S SOl�)ii�/d% Signature LIC. NO.: ., ((f applicable, suer "exempt' in the license number line.) Bus. Tel. No., %��G Address: Alt. Tel. No. OWI%ZR'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. n,,,. OAoent — . . I PERMIT FF.F.: s ;fl