HomeMy WebLinkAboutBLDE-21-002757 BLD G (2) •
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c7 Permit No. —2,•-_-_-_,7) ` 5
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( ...Ill?'... NIF f1 Occupancy and Fee Checked
,1 . _ r . BOARD OF FIRE PREVENTION REGULATIONS fRev. 1/07]
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
u..)i All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 l�td�(Z0
',' ` City or Town of: (s3 Va.(plotAt To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical.unrk described below.
(.,3 s Location(Street&Number) 2-Lk Ct CaeAp j $U l Id , tNe _
Owner or Tenant .f0A W4:4 S C0c a +C'c)S'i- Telephone No.
(. Owner's Address
v--) Is this permit in conjunction with a building permit? Yes Er No El (Check Appropriate Box)
LA Purpose of Building t71M2\1,rt S Utility Authorization No.
:'? Existing Service Amps J / Volts Overhead 0 Undgrd 0 No.of Meters
e.
• - New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
l-
c..)- Number of Feeders and Ampacity
Location and Nature of Propos Electrical Work: Ve.p k 01/4(.4. cl-tj \k 0 U t&do C (-,S11t S l k K
o U\- r \c51.ks o L c C Ou3S / ref&k1/4-0,6\ Mt, b evx K
Completion of the following table m be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Cell:Sus . Fans Toan.or KVA
p (Paddle) Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPool ' 'ove n- 'o.o Units mergency g -ng
grad. ❑ gird. 0 Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Initiating on Deteand
Devices
No.of Ranges No.of Mr Cond.
Tota
llo.of Alerting Devices
Disposers Neat Pump Number, Tons KW No.of Self-Contained
No.of Waste Dis
p Totals: .. Detection/AlertinLDevices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW `Seeurity Systems?
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring: -
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP 'Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail ifdesired,or as required by the Inspector of Wires,
Estimated Value of Electrical Work: �`0 00,,,, (When required by municipal policy.)
Work to Start: 10 11,57 7...0 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cove is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [ BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties ofperju ,that the information on this application is true and complete.
FIRM NAME: 1,cy,Iyt.(' e.( Cf e i'C. .-� LIC.NO.: 2.11-]G !\
Licensee: \-)c vv 3.0 %A e.,C. Signature LIC.NO.: 1 V v'S`A
(If applicable,enter"e"ewer"in the lids number fl e) ° Bus.Tel.No.:5027, N.‘-1, 01
Address: !]t`a I), SV.t:a�3 .1-() kketi\(\t.;1) Alt.Tel No.: �
*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 ❑owner's agent.
Owner/Agent
Signature Telephone No. L PERMIT FEE: $