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
Yq
,,,.,49'_ (OFFICE USE ONLY)
T WN-O Y TH B emI !!SE j % _� .+,y� Fee: $ a7C Lre)
!/(.1 t.' _, 8, 2004 `U ,1 PERMIT NO. Z D t4- ,3k-3
(PLEASE PRINT IN INK I R TYPE ALL INEORMA7�ON) Date: 6"g -0y
' To the Inspector of Wires: : 1' _ - r...,:,;‘,.. _.i +Iv-timiksigned gives notice of his or her intention to perform the electrical
work described below. /, /
Location (Street&Number) 7`7" /7A-1.4J A-1^Mwetur DZ-
Owner or Tenant f % /^J Telephone No.
Owner's Address ,c4/i -
Is this permit in conjunction with a building permit? CA Yes LNrr (Check Appropriate Box)
Purpose of Building S '-'i(t Alli[/ Utility Authorization No.
Existing Service (6,O Amps /7O / z- 'Volts Overheada"- Undgrd Q No. of Meters J
New Service Amps / Volts Overhead Undgrd 0 No. of Meters
Number of Feeders and Ampacity
ocation and Nature of Proposed electrical Work: 1^11/46 f 4.7,-- , --.61-44/4.47
Completion of the following table may be waived by the Inspector of Wire..
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
�) Above In- No. of Emergency Lighting
No. of Lighting Fixtures Swimming Pool grnd. ❑ grnd. ❑ Battery Units
No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones
l No. of Detection and
c� No. of Switches No. of Gas Burners Initiating Devices
Total
�. No. of Ranges No. of Air Cond. Tons No. of Alerting Devices
Heat PumpNumber Tons KW No. of Self-Contained
No. of Waste Disposers Total : _Detection/Alerting Devices
Municipal
No. of Dishwashers Space/Area Heating KW Local riConnection Other
Security Systems:
No. of Dryers Heating Appliances KW No.of Devices or Equipvalent
0 No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent 1
No. Hydromassage Bathtubs No.of Motors Total HP /
----
Telecommunications of Devices or EWquivalent i
( �,� /'fes No.of Devices 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.
CHECK ONE: INSURANCE BOND❑ OTHERQ (Specify:)( ,6I4VL J O 0--C
(Expiration Date)
51 Estimated Value of Electrical Work: (When required by municipal policy.)
/
Work to Start: ( P k-0`/ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under th pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: (51z-40 ,CCA-4/7/E-1 4-- LIC. NO. /4-9/y 7
=� Licensee: "V'h (Ai .SiL y+G,-4i- Signature LIC. NO. JrZ✓C SI
e (If applicable, enter"exempt" in the license number line.) Bus. Tel. No.: 0i- . Z.i''T'Q S L
Address; Alt. Tel. No.:0[)€-Y`Lf- 51/F b
,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)owner owner's agent.J
Owner/Agent
Signature Telenhone No.