HomeMy WebLinkAboutElectrical Permit,
l � The Commonwealth of Massachusetts Use Only
• 77 .
96 4-7: ('r roll b.
A , 1 '�� . Department of Public Safety
Occupancy d ret Checked
! Iiii"
i � BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (teat blank)
IF APPLICATION FOR PERMIT TO PERFORM ELECTRIC aP V' I —,
iAll work to be performed In accordance with the Massachusetts Electrical Code. 527 CMR 12:'( IF
(PLEASE PRINT IN INK OR. TYPE ALL INFORMATION) Date ..'� -- AUG 2 0 1998
City or Town of V/34-1114/11714 To the Inspector of Wi es : J
The undersigned applies for a permit to perform the electrical work described below. By ���
Location (Street & Number) 1/0 0{-0#2 57 S y,4 �r,g
Owner or. Tenant ,4L1/'i. '
Owner's Address ., c.ccL•
. Is this permit in conjunction with a building permit: Yes ❑ No Q/(Check Appropriate Box)
Purpose of Building go-.4,c4 440141 tho Utility Auization NO.
Existing Service /0 ) Amps / Z.-Id / Z(49 Volts Overhead [ Undgrd❑ No. of Meters 7
New Service Amps / Volts Overhead ❑ Uddgrd❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work j/i1//L . .5*si,reC6,12-.C/r04- ?tine y
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
RVA ,
- No. of Lighting Fixtures Swimming Pool Above In-
grnd. ❑grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners BatteryUnitsncy Lighting
• No. of Switch Outlets No. of Gas Burners FIRE ALARMS No: of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tons Initiating Devices
No. of Disposals , No. of
Heat
Total TotalTons • No. of Sounding Devices —,..,-.1._.
No. of Dishwashers Space/Area Heating RW No. of Self Contained
Detection/Sounding Devices
No. of Dryers heating Devices KW Local❑ ConMunnecticipalion❑Other
No. of
ti No. of Water Heaters Signs( Ballasts Low Voltage
-- Wiring
• No. Hydro Massage Tubs No. of Motors Total HP
OTHER: .
•
Q
l
..,( INSURANCE COVERAGE: Pursuant to ;he requirements of Massachusetts General Laws
�\ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES❑ NO I have submitted valid proof of same to this office. YES❑ NO 0
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
S) INSURANCE 0E(B-OND 0 OTHER❑ (Please Specify) ( d (4'4' lAtio 7 7 •
Estimated Value of Electrical Work $ g?17D (l':xpiration Date)
I Work to Start y--/ - � { ,/7-2F P—f f'— IC
\h\ i 7:.
Inspection Date Requested: p Rough Final
Signed under the penalties of perjury:
FIRM NAME/vd� tjG l G
LIC:•10.A,/ki7
e T
cLicensee .0$ * hf(i(R 4. Si nature G
6-. J �, S� 8 LIC. NOW..- �6 7
Address <De �!u0t 4 D ,aJoL,d Q d j4'37Bus. Tel. No. _ — , , L
v Alt. Tel. No. - p
OWNER'S INSURANCE WAIVER: I am-aware that the Licen does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
' V) application waives this requirement. Owner Agent (Please check one)
643 V t Telephone No. PERMIT FEE S
Na (Signature of Owner or Agent)
"
I
,