HomeMy WebLinkAboutBld-21-005859 $4 Commmnwea[tk o/Maeeachae.le Official Use Only
Permit No. �iQ S�99
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t; - ;• Occupancy and Fee Checked
p BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
S All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12.00
£ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Ili g aoa\
• Cit
y or Town of: q{�oV�'h To the Inspector of Wires:
is By this application the undersign gives notice of his or her intention to perform the electrical work described below.
e Location(Street&Number) PI q StO1t 00 A06
Owner or Tenant 3€,SS‘,C.o. C.CO .e.(- Telephone No.S03-41-Ot-37eb
< Owner's Address
cIs this permit in conjunction witha building permit? Yes Di No ❑ (Check Appropriate Box)
Purpose of Building It e5-, te\-1c;A Utility Authorization No.
Cij Existing Service '00 Amps 0-0 /aLa Volts Overhead[21 Undgrd 0 No.of Meters
New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
• Number of Feeders and Ampacity
L Location and Nature of Proposed Electrical Work: Tall C.I C N ay19L-, MA -e`eCtr C. 44 ecct, g
E A �QCC S.s its , Add, o�ik�f�5.
nCompletion of thefollowin&table stay be waived by the Inspector of Wires.
Ui No.of Recessed Luminaires 7 No.of Cell.-Susp.(Paddle)Fans No.of Total
I Transformers KVA
-1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
r\
No.of Luminaires Swbnmin Pool Above ❑ In- ❑ NO.of Emergency Lighting
g and. Ernd. Battery Units
No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection ands
No.of Switches aZ No.of Gas Burners
c Initiating Devices
!:1 No.of Ranges No.of Air Cond. Ton No.of Alerting Devices
No.of Waste Dispoeera Heat Pump Number s KW ‘No.of Self-Contained
Totals: Ton _ _ Detection/Ale ' Devices
No.of Dishwashers Space/Area Heating KW Local 0 glued on 0 Other
ecti
No.of Dryers / Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water , "No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
a No.Hydromassage Bathtubs No.of Motors Total HP Tel of Devices o omm e r Wig
No. vices or Equivalent
OTHER:
Attach additional detail if desired or as required by the Inspector of Wires.
,,/ 1 Estimated Value of Elec 'cal Work: ' 3 000 (When required by municipal policy.)
7� '� Work to Start: ilei ( Inspections to be requested in accordance with MEC Rule 10,and upon completion.
-- - INSURANCE COVE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
4/ ' 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.
S(( u CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties ofpalmy,that the information on this application is true and complete
FIRM NAME: i CPlae,l G(aSht-i't LIC.NO.: �3�1�
Licensee: �i G ae.l G 1 i„,..-
aS�l i-c✓1 Signature
LIC.NO.: I �( IS(Ifapplkable,enter"exempt"pt"in the license number line.) Bus.Tel.No.:77 Y-$3 6-A511
CI( Address: 5"GefTerbCook LAI C-et1lei V.1\e t MA c• -(011 Alt.TeLNo.:50$-Sat-Pal
41 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
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 Z
Signature Telephone No. PERMIT FEE:$7S