HomeMy WebLinkAboutElectrical Permit APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
M work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
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Ogg
MATTACNEESE
r/ 7 � Fee: $
iP'-r DEC 14 2i01 J
PERMIT NO. E -61:7 4114 96/
(PLEASE PRINT IN INK OR 7 Eh AI.1 INFORMATION) Date: /cat/YCC> J
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below. 7 / �.,,�r , '
Location (Street&Number)D �lt 7& FEC5O t AVE elm/'— Yoipmec
Owner or Tenant Ro C7 U LCOCA4 Telephone No.
Owner's Address <Mkt&45 4 * cs
Is this permit in conjunction with a building permit? 71 Yes 0 No (Check Appropriate Box)
Purpose of Building EXA5 /1[& / r- Utility Authorization No.
Existing Service /61Chmps / / giQVolts Overhead._ Undgrd fl No. of Meters
New Service Amps / Volts Overhead Undgrd 71 No. of Meters
umber of Feeders and Ampacity ;�y� �-�..(
ocation and Nature of Proposed electrical Work: ..L, 54L EPI-IC t.�a aM}�PO iikelAtitijj)
/G7K \
Completion of the following table may be waived by the Inspector of Wires
No. of Total
No. of Recessed Fixtures No. of Ceil. Susp.(Paddle) Fans Transformers KVA
No. of Lighting Outlets No. of Hot Tubs Generators KVA
Above In- No. of Emergency Lighting
No. of Lighting Fixtures Swimming Pool grnd. 71
grnd. BatteryUnits
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones
No.of Detection and
No. of Switches No. of Gas Burners Initiating Devices
1' No. of Ranges No. of Air Cond. Tons] No. of Alerting Devices
Heat PumpNumber Tons KW No. of Self-Contained
No. of Waste Disposers Total : Detection/Alerting Devices
Municipal
No. of Dishwashers Space/Area Heating KW Local il Connection Other
Secutity Systems:
`,; No. of Dryers Heating Appliances KW No. of Devices or Equipvalent
No. of Water No. of No. of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP
Telecommunications o Devices or Equivalent Wiring:
No.of Devices Equivalent
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 be issued unless the licensee provides
4
proof of liability insurance including "completed operation"coverage or its substantial equi lent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office. p
CHECK ONE: INSURANCE r- BOND OTHERO (Specify.
S ecify ��� 60171.4r LY
(Expiration Date)
Estimated Value of EleFs,rical Wor W-di (When required by municipal policy.)
Work to Start:ip ..` 62 r Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, underj.he-pains 9,0 .e alties of per'ur , that tie i formation on this application is rue and complete.
c) FIRM NAME: if iir i L/ R.01 llr . : IC. NO. 1,5:1
Licensee: Signatur: //AA.E 1 1 LIC. NO.
A—(If applic le, enter "exem t" in the cense nu er line.) Bus. Tel. No.: 9- 07(�
Address•ro y-- 7 tut/pie � Alt. Tel. No.: 3' 4
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norma ly regired by9aw. y my signature
below, I hereby waive this requirement. I am the (check one)owner El owner's agent.0
Owner/Agent
Signature Telephone No.
[Rev.04/00]