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HomeMy WebLinkAboutElectrical Permit A 121 I © 1 1] mwsonwaa00hof Maddeh tttd Official Use Only Ie -'t JUL 2 1 08 Permit No. E09 Y inI apartaumt 01 girt Serviced 1( H..S�_. ';/:-'="." -IOccupancy and Fee Checked '00 _ PREVENTION REGULATIONS (Rev. 1/07] (leave blank) - APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK r— All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.0 V�oc(PLEA i PRINT IN INK OR TY ALL INFOR T N) Date: 7—I Z' —6 ruul�',o a ity or Town of: /f�/l0 To the Inspector of Wires: y t'is:•plication the undersigned ves notice ff his or her intention to perform the electrical work described below. . I-Loc ti. V®`�c ( 2 (Street&Number) L ' c_ 0 t M5Dw er i r Tenant 5 CC F CM .'f,' 1 tiN! Telephone No. Q4h3wne Address 11 Is thl-;'� rmit in conjunction with a buildingpermit? Yes --•••— , ] 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd 0 No.of Meters New Service Amps I Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J ,5-6/..;r- ... si-2,5 i Completion of the following.iable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-SusP (Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs ' Generators KVA No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and ItO Initiating Devices Total � ®.. No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump lYumber.:Tons..,-.... KW No.of Self-Contained Cr' No.of Waste Disposers Totals:_ Detection/Alerting Devices TN, No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection ❑ Other -.`. No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Data Wiring: Sins Ballasts 1z No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 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 pe it issuing office. CHECK ONE: INSURANCE£---BOND 0 OTHER 0 (Specify:) J5 ///t- ri /L V3 I certify, under the pains and milticeis of er,/ury,that the in ormation on this application is true and complete. _ FIRM NAME: -V-0 / EG��� /�'/�} LIC.NO.: . 4'5-.6 Licensee: Signature t -• L„ir v' LIC.NO.: L (If applicable mpt"inhelcense number enJe.( ��7l / Bus.Tel. No.: gP 76'� Address: (-V/ Alt.Tel.No.: /-57544f"2 5` i"- *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie. No. V v " OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $