HomeMy WebLinkAboutBLDE-21-000520 e;nrmeanaieaRh.1 assackaaifa Official Use Only •
( °Perla a'i o`.fii+e vices Permit No.., `Q S ZA
' .. Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev. !/07j heave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AD work to be performed in accordance with the Massachusetts Electrical Code MEC), 27C R 12.00
(PLEASE PRINT IN INK OR ALL INFOR TION) Date: 7 .
City or Town of: YaIt A 0 To the Ins dor of WI •s: E C ,
By this application the undersi ves notice Phis o her intention to perform the electrical work r .-. be o .
Location(Street&Number) li W 00 40._ s
Owner or Tenant Tele,., , , 4.a2Q
Owner's Address e 'auks
Is this permit in conj ctioa the nil permit? Yes
0 No ►�1 (Check Approp'�: .�, t'f
Purpose of Building S(� Utility Authorization No.
Existing Service Amps / Volts Overhead 0 L?adgrd❑ No.of Meters
New Service Amps / Volts Overhead 0 Uadgrd 0 No.of Meters
Number of Feeders and Ampacity
ti, , ad Nature of Proposed E trical Work: l` 4-601C^ t'— Ck .A },L U L,�rj
• - SwLkS— . 5 40 lam - 1
1 � � �
Completion Af the following itable sway sle.of be waived hs the fe�r�r gt'Wir�.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans
Trausforruers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPoet Above In- lvo.of I•.mergency�Lighnag
grad. ❑ grad. ❑ ,Battery Units
No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.oI Detection aid
Initiating Devices
No.of Ranges No.of Air Coad. TontsNo.of Alerting Devices
No.of Waste Disposers Heat Pump Number,Tons_..sKW..,_• 'No.of Self-Contained '
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KWLocal 0 Menleieem 0 Otiwr
ems:4
No.oices rEauivalenNo.of Dryers Heating Appliances KW 'Scant*
Equivalent
No,of k-�, No.of No.of Data Wi
f
Water
Signs Ballasts No.ofR ices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TeleeommuaICatilna I
Hydromassage
No,of Devices or Eanlea at
OTHER:
Attach additional detail if desired.oras required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
OPINSURANCE 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
6 r, undersigned certifies that such 'verage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE :1 BOND 0 OTHER 0 (Specify:)
I curet,under' y, ,, an, ,,• :,, ., of .th the,information on this application is true and cotnplet�G / ``)'
FIRM N f: ,' - P t • �C.l. LIC.NO.: 1"l `��
Licensee: -- * - . — _ # Slgnatn LIC.NO.:
`r If
applit obi t reit , i. . sober Inc.) , + Bus.Tet.Na:
' ,�/"A Addn�as: ( `WCL(+ l� �f Alt Tel.No.:
(( `Per M.G.L.c. 147,s.57-6!,secure work requires�nt of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: Iam aware ti t the Licensee does nos have the liability insurance coverage normally
required by law, lay my signature below.I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent.
Owner/Agent
Telephone No. I PERMIT FEE:$