HomeMy WebLinkAboutElectrical Permit :TPOPLWICNAOTFlOyNAFROIRRoPuEHRMIT TO PERFORM ELECTRICAL WORK
All work to be performed in acco d is Electrical Code, (MEG), 527 CMR 12.0C
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UEC272,005
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R PERMIT NO. l�_���%�
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: l g 6.5"-
'To the Inspector of Wires: By this application the undersigned give, :;: or her intention to perfo • /KM•lectrical
work described below.
Location(Street&Number) , - - � K �,(,
Owner or Tenant Telephone Nom �`'"�/��}
sr N:e
Owner's Address �
[s this (
permit in with a building •permit? f
conjunction permit. � Yes �No (Check Appropriate Box)
Purpose of Building Utility Authorization No. .5
Existing Service Amps / Volts Overhead Undgrd 0 No. of Meters
New Service Amps / Volts Overhead Undgrd 71 No. of Meters_
Number of Feeders and Ampacity PEP
Location and Nature of Proposed electrical Work: /01/�lam' Eti C
Completion of the following table may be waived by the Ins,ector o Wires
o. of
Transformers
otal
No. of Recessed Fixtures No. of Ceil.-Susp.(Paddle)Fans KVA KVA
No. of Lighting Outlets No. of Hot Tubs _ Generators KVA
, - No.
� g No. of Lighting Fixtures Swimming Pool Abovernd. Irnd. Bat of Emergency Lighting
* . g 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 RangesTotal
g No. of Air Cond. Tons No. of Alerting Devices
No. of Waste Disposers Heat PumTotals: Number Tons KW No. of Self-Contained
0 ' Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local (1 Municipal
Connection El Other
No. of Dryers Heating Appliances KW Secutity Systems:
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 Wiring:
No.of Devices or 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
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 permit issuing office. ��r,,.���
CHECK ONE: INSURANCE BOND OTHER (Specify:) U �`Z C
Estimated Value of Electrical Work: (Ex (ration Dile)
Work to Start: (When required by municipal policy.)
�^, q9 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
`1,) I certify, under th- ..'ns .• -nal'e o....4,• 'ury, .t the information on this apilication is true and complete. f,
FIRM NAME: �JL1 .i lb C 4` LIC. NO. �'�1 v
Licensee: Signature �'Ari
(If appli 'evil.'ter`"exempt"in th license n ber ine. IC. NO.
Address 0 t�- 6F7 U..)t t(�� �( Bus. Tel. No.: �jr�
OWNER' INSURANCE AIVER: 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)owner owner's agent.0
Owner/Agent
Signature
mo., nmm�, Telephone No.