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HomeMy WebLinkAboutBLDE-21-000438 COMMOMV0ah 01 MaddacFuedsth Official Use Only , �.:2- —C t 5e) G ,a;_ .y 2eparbn.nE o�,..tio*.Services �' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONSRev 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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: O1-L1 /.202O City or Town of: c1`Tl YoriyiaA To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to rform the electrical work described below. Location(Street&Number) 1111 Owner or Tenant , ifsf y i ev-) 23 Owner's Address Q hl Is this permit in conjunction with a building permit? Yes ❑ No ® ` . . - t 7 • n Purpose of Building Utility Authori zatioob U Existing Service_ Amps / Volts Overhead❑ Undgrd❑ No. New Service Amps / Volts Overhead❑ Undgrd c No.of Me . Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1; .1 f t 0F, 4.... l 11 ,,,,„ '11'ylon Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceii.Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 110 Swimming Pool Above ❑ In- IDNo.or I mergency Lighting grad. grnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 'No.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Tons No.of AlertingDevices Tans No.of Waste Disposers Heat Pump I Number Tons _J_KW No.of Self-Contained Totals: _...__.._. ...,...._. o Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Connection Municipal ❑ Other No.of Dryers Heating Appliancesy 'sty Systems:* No.of Devices or Equivalent No.of Water .No.of No.of Heaters 1' Signs Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:lr'y/tdE,ZeQf) (When required by municipal policy.) Work to Start:OK,byJaQ,a)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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this a lication is true and complete. FIRM NAME: Vol e,11 etE(.Tr ICr Y.tJC LIC.NO.: a I Q SS A Licensee: (l Aix; .to V• A U .° Signature LIC.NO.: of applicable,gnat "exempt"in the license number 1in .) Bus.Tel.No.•MR))rD t$-g)VI Address: `I do f l 0 iLT oN b`f t f` n-1irl5h OWN fl D f 1 i') AIL Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ 4 eYIA+I : VV.:Teat C©0-purA T;04 e 01m11.i •CAYr1