HomeMy WebLinkAboutClosed electrical permit APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
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(PLEASE PRINT IN INK OR TYPE ALL IN OFATION) Date: 3 - I t `d 5
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below.
Location (Street& Number) i•6 IZ.0 U T 2, L1
Owner or Tenant R P - �---o b S ?�'�`Z `0 6- ✓ r el Telephone No.
40-
Owner's Address S et.lei —
Is this permit in conjunction with a building permit? rl Yes et No (Check Appropriate Box)
Purpose of Building r?—e c.-aThkc%` ..4 K`t Utility Authorization No. N A
Existing Service4 O 0 Amps 1. 1•O /2.08 Volts Overhead Undgrd No. of Meters
New Service Amps / Volts Overheadt Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: ( A-- CO m t v C-TO cv t
T7.1 c K A i' v a. 3--)L - ..) IA r-ct Ae7(.P K c.
Completion of the following table may be waived by the Inspector of Wire:
No.of Total
No. of Recesse. ures No. of Ceil.-Susp.(Paddle) Fans Transformers KVA
4
t�i No. of Lighting Outlets No. of Hot Tubs Generators KVA
Above en In- en No. of Emergency Light'
a No. of Lighting Fixtures Swimming Pool grnd. grnd. Battery Units
v No. of Receptacle Outlets No. o '.1 Burners FI' - - ARMS No. of Zones
'o. of Detection and
No. of Switches No. of Gas Bu Initiating Devices
No. of Ranges No. of Air Cond. Tons No. of Alerting Devices
Heat PumpNumb• Tons , KW No. of Self-Contained
No. of Waste Disposers Total : — ' —— ——Detection/Alerting Devices
No. of Dishwashers Space/ a Heating KW -•• al MunicipalConnection Q Other
No. of Dryers 'eatingAppliances KW Secuti • stems:
r, Y PP No. of es or Equipvalent
No. of Water No. of No. of Data Wiring:
\� Heaters KW Signs Ballasts No.of Devices or >..' alent
'
No. H dromassa e '.thtubs No. of Motors Total HP Telecommunications of Devices or Equivalent
Y g 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 t} BOND ElOTHERO (Specify:)
N r (Expiration Date)
Estimated Value of Electrical Work: / 1 00 (When required by municipal policy.)
C Work to Start: 3 "i S.- 0 S Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Li 14-e, tt i 4,c,-t a.i.'4-• LIC. NO. t c(0 4 6
Licensee: - . ., L..,i f-l? Signature 9cy2'`L 7 LIC. NO.' 30q:i 4
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: S D 00 2. �.
Address [?GX (? OO (,0 , Nh 'T i`1 to. Q Alt. Tel. No.: C 4tel G
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 Q owner's agent.f
Owner/Agent
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