HomeMy WebLinkAboutElectrical Permit APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Elea rrical Code, (MEC), 527 CMR 12.00
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JUN 2 0 2006 PERMIT NSD. L-06 — It a,
t/,,. ... e, •%Z �:)ate:
PLEASE PRINT IN IN 0 ' Eli V. 41%, n•' ATION)
';' e.._... : .e • •- ndersigned gives notice of his i)r her in enti n to perform the electrical
o the Inspector of Wiry � A -�� g
Cork described below.
Location (Street&Number) 317 lT a A
Telephone No. U! 3 1 Z006
Owner or Tenant fiLGk� 4/112.5;9// i
Owner's Address
Xf/l�GeThi1a�) A, I - ' -
%s this permit in conjunction with a building permit? El Yes Eli No (Check "appropriate Box)
V Purpose of Building )%, G d/J` Utility Authoriz:.tion No.
Existing Service Amps / Volts Overhead Undgrd 71No. of Meter
New Service Amps / Volts
Overhead Undgrd El No. of Meter
Number of Feeders and Ampacity • g A e- 0 77fil4k
Location and Nature of Proposed electrical Work: 614 ) So /
IN ` Completio 1 of the following table may be waived by he Inspector of Wires
No.of Total
0I- No. of Recessed Fixtures , No. of Ceil.-Susp.(Paddle) Fans Transformers KVA
' nl No. of Lighting Outlets No. of Hot Tubs Generators KVA
AboveIn- No. of Emergency Lighting
No. of Lighting Fixtures Swimming Pool grnd. El grnd. Battery Units ,
c, FIRE ALARMS No. of Zones
' No. of Receptacle Outlets No. of Oil Burners
No. of Detection and
No. of Switches No. of Gas Burners Initiating Devices
Total No. of AlertingDevices
No. of Ranges No. of Air Cond. Tons
Heat Pump ' Number Tons KW No. of Self-Contained
No. of Waste Disposers Totals: Detection/Alerting Devices
Municipal
No. of Dishwashers Space/Area Heating KW Local 0 Connection 71 Other
Secutity Systems:
No. of Dryers Heating Appliances KW No.of Devices or Equipvalent
No. of Water No. of No. of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
Telecommunications Wiring:
No. Hydromassage Bathtubs No. of Motors Total HP 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 elc r.:trical work may be issued unless th- licensee provides
If
proof of liability insurance including"completed operation"coverage or its substantial equival.,:nt.The undersigned certifies that s ch coverage is in
orce, and has exhibited proof of same to the permit issuing office. >i Q
CHECK ONE: INSURANCE BOND El OTHEREl (Specify:) ..
(Expiratio Date)
kEstimated Value of Elecft cal W/ork: (When require'l by municipal policy.)
Work to Start: 6,/,,,/ a Inspections to be requested in accordance with MI:C Rule 10, and upon completio .
,,I certify, under the Rains and penalties of perju , that the information on this applica.ion is true and complete.
FIRM NAME: X/ T� �C d ,] LIC. NO.
Licensee: PAHA y%4 4' e- Signature 4n,._/ J(4-r✓-'! LIC. NO. e ''
U(If applicable, enter"exempt" in the license number line.) , us. Tel. No.:
Address ZA Gam' e6 -4arrte'Awl. 02t - .._Alt. Tel. No.: . - W•
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability in:; France coverage normally required by law. By my signature
'below,I hereby waive this requirement. I am the (check one)owner 0 owner's agent.j'1
Owner/Agent
Signature Telep:Lone No.