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=.3rr= JJeParfmcnt o{.Jur Jcrviva —.Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev. 1/07] (leave bleak)
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L APPLICATION FORIPERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance wit the Massachusetts Electrical Code(MEC),527 Oa 12.00
o (PLEASE.PRINT INMIK ORTYPE ALL INFORhw4TI0N) Date:
—IT
W City or Town of yARMQf •To the Inspector of Nares:
N �� . By this application the pndersigned fres notice o his or her'.. en/ to perform the electrical work described below.
W O Location (Street&Number)
o g •
Owner orTenant J)e 5 A , , Telephone No.
W ¢ Owner's Address
ce m . Is this permit in conjunction with a building permit? Yes ❑ No ®/TCheckApproptiate Boz)
Purpose of Bnitang
alit),Authorization No. 2-2` 522.7 71
Existing Service/on Amps (7_0/2✓ otts Overhead
f./�r Efr"---IIndgrd❑ No.of Meters
New Service �e77
s fJf' 'Amps /2,e,' 8volts Overhead 11.--
n/— u�ndgrd E No.of Meters
Number of Feeders and Ampaeity •
rT
Lo• �catio�n7an,d,,Nature of Proposed ee tiical Wort St dr: /
Completion of the foffowi ar table may be waved by the Irsoector ofFPtrer.
No.of Recessed Luminaires ' INo, of Cett Susp.(Paddle)Fags • P.of Total
Transformers INA
No. of Lnmi...ire Owes No.of Hot Tabs Generators • EVA '
• Na of Ltrmitaires ISwimmiag Pool Above 0 Ia- INo,of i.mergeacy Irghung — .
erred. erred. Battery Units
Nn. of Receptacle OatL-*s 'No. of OE Baraers
E ALARMS No.of Zones
No,of Switches !No.of Gas BurnersNo.of Detection an
Luitiatinu Devices
No.of Ranges INo, of Air Cond. Tots Aso.of A.iet4ag Devices
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No.of Waste Disposers Heat Pump I Number I'Toas 1 KW 'No..of Self-Contain- d
Totals: D,_c-tion/Alertiae Devices
No.of Dishwashers Space/Area Heating KW' Local Q Mtnutnet l
Connection 0 Other
No.of Dryers Heating Appliances Kr Security Systems:"
V No.of Water
No.of Devices or Equivalent
FIeaters KW No. of No.of Data Wiring:Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring;
No.of Devices or Equivalent
OTHER _
Estimated Value of Electrical World Attach additional detail rfdesred,or a required by the Inspector of Wires.
Work t Start (When required by municipal policy.)
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 electical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or it substantial egSalent The
. undersigned certifies that such coverage force,and has ezhlbited proof of same to the permit issuing office.
\, CHECK ONE: INSURANCE OND ❑ OTHER 0 (Specify.)
I cer>rfy, tinder the
1 p• =die °fPQ7 ,. •r#the information on this application is hue and complete.NAME:
de_ yt. .47- ./ar ' ! C LIC.NO
itizazg
• Licenser. 4 '.iii ✓,y✓ w
p-kens mble, e. tri,..- �/ � ear LIC.NO:
s- ' •t"in the '.LF Apr 1 ., Bus.Tel.No. - ...'tZ
Address •eL // l. , /Ja;. �Atir, ' ✓ '
J Per M.G.L.c. 147 - 57-61,securi w.• ti -- Alt Tel No.: _ Vxj
OWNER'S INSU' Ty requires Department Public Safety"S"License: Lie.No.
- law. By my signature WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally
- rerequired by la I rare below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent
Signature Telephone No. I PERMIT FEE:$ `5h./1