Loading...
HomeMy WebLinkAboutElectrical Permit " : i ' 8 TION FOR PERMIT PERFORM ELECTRICAL WORK K .__i All work to be perform ed in accordance with the Massaetts Electrical Code,(MEC),527 CMR 12.00 `2' i,----, t E © C, [I`M `i (OFFICE USE ONLY) .. Y A • i mow- , � v i Z 5 O - NOV - :--itiflRALTH p ► `, ,- - (PLEASE PRINT IN INK I r. ' , �� "SN) Date: ' /1 C12.E To the'Inspector of Wires:By this> *.= €r = X11: signed givesnotice of his or her intention to perforin the electrical work described below. 1 YLocation(Street&Numb ) ` Q F� Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? 11 Yes ri No (Check Appropriate Box) Purpose of BuildingL.. t)y ,. _1 1 Utility Authorization No. Existing Service-/ O Amps /040 /G VOVolts SCh rhead ... Undgrd 11 No. of Meters New Service Amps / Volts Ovliead Undgrd II No. of Meters Number of Feeders and Anpacity Location and Nature of Proposed electrical Work: f t "( ti 1 C� S ys - - Completion of the following table may be waived by the Inspector of Wires 4No.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 Swi*n— Ppol ,grad grad. ;I Battery Units 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 No.of Ranges No.of Air Cond. Tons No.of Alerting Devices : i Heat Pump Number Tons KW No. of Self Contained No.of Waste Disposers Totals: ———-——-———Detection/Alerting Devices '.VMunicipal No.of Dishwashers Space/Area Heating KW Local Connection 0 Other ._ Secutity Systems: . No.of Dryers Heating Appliances KW Na of Devices or Equipvalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent I No.Hydromassage Bathtubs No.of Motors/ Total HP 1 Telecommunications or Equivalentg t 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 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 permitissuing office. CHECK ONE: INSURANCE BOND( OTHER) (Specify:) . (Expiration Date) Estimated Value of Electrical Work: 3f7 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the 's *r a.ig e. on t3 is;...elication. = e and complete. FIRM N ,i LIC. NO. icensee: % r U t 1 h Signature ,r.�1,..:=:,wr ` < ,,,„,,3. LIC.NO. �� E If appli enter"exeda€*° . sen =e' line., .. :us.Tel No.: 3f�/" 7 // Address: (i B" 4 A?, i Mt Alt.Tel. No.: OWNER'S INSURANCE WAIVER:I am aware that the Iticensee does not have the liability insurance coverage normally required by law.By my signature below,I hereby waive this requirement.I am the(check one)owner c3 owner's agent.0 Owner/Agent Signature Telephone No. fi?pa, 11A/Mi