HomeMy WebLinkAboutElectrical Permit APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code. (MEC), 527 CMR 12.00
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EVE -IOCT 2 ` ?Qui Ui .i° 0 2 2092: $ 40- C,16
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„LTH DEWWIT NO.
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r PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Oct 2R a C 0..2
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below.
Location (Street&Number) I 1 Allopurriot-ac'
1
Owner or Tenant C'la t r t? 1.-.4:444r0 , Tr . Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? 1 Yes 0 N (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead Undgrd 71 No.of Meters _
/New Service Amps / Volts Overheadr7 Undgrd n No. of Meters _ _ ___
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: Wer...4 45tiG /)`""f' cla.. e«0-
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
i Above In- No.of-Emergency Lighting
i No. of Lighting Fixtures Swimming Pool grnd. grnd. Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones
No. of Detection and
0 No. of Switches No. of Gas Burners Initiating Devices
1. r _ Total
In No. of Ranges No. of Air Cond. Tons No. of Alerting Devices
+' Heat Pump Number Tons KW No. of Self-Contained
'_ No. of Waste Disposers Totals: Detection/Alerting Devices rr--�77 Other
Municipal -
1 No. of Dishwashers Space/Area Heating KW Local Connection
'1 No. of Dr ers Heating
A liances KW Secutity Systems j
y pp No.of Devices or Equipvalent
r No of Water No. of No.of Data Wiring.
Heaters KW Signs Ballasts No.of Devices or Equivalent —a
}� __Heaters
Telecommunication.r.-
No. Hydromassage Bathtubs No.of Motors f Total HP i!/0 No.of Devices c . a Ilt7
•+ V. is rector of �l�.s.
INSURANCE COVERAGE:Unless waived by the owner no permit for the performance of electrical work may be i.1
Attach additional detail if desired, or as req I of��• t : IZet, 2ro
proof of liability insurance including "completed operation”coverage or its substantial equivalent. The undersigned • rti les „.--•
such coverage i
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force, and has exhibited proof of same to the permit issuing office. By v
'1E1HFCK ONE: INSURANCE fa BONDr1 OTHER (Specify:) 01 a a ■, -71_
Q. (Expiration ►ate)
0"Estimated Value of Electrical Work'°o0 (When required by municipal policy.)
S Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I ratify, tinder the pains and penal}�les o perjury, that the information on this application is true and complete.
FIRM NAME: ; " ea'! LID ,1e ?ze: LIC. NO. 139ySA
"t icensee: Signaturei...5frgok> / LIC. NO.
(Il applicable, enter"exem t" in the license number line.) Bus. Tel. No.: 508-- Y3�- S'-2.
I. Address._ .J C , k -wre.2 /VA_ O.ZG yS Alt. Tel. No.:
O\Ar NEWS INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
bekn . I hereby waive this requirement. I am the (check one)owner 0 owner's agent.Q
(lt[ct Arent
Signature Telephone No.