HomeMy WebLinkAboutB;DE-21-000603 (commonwealth o///Ialoachu.setla Official Use Only
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►' » _ ` i ;�t 2 c� Permit No.
epartment o/Jim.Services
"i = [(—5 Occupancy and Fee Checked
.- i BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
.It,�_1,1.
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: $/6/ZD
City or Town of: ENIIIIIIIMIRE t f/ovi- 1 To the Inspector of Wires:
By this application the undersigned gives notice of his 6r her intention to perform the electrical work described below.
Location(Street&Number) /0 , -"41 bA 6, N�� Map Parcel#
Owner or Tenant ✓,�NiS M 4S01 / Telephone No.
Owner's Address 5A rv•-•2
Is this permit in conjunction with a building permit? Yes ❑ No d (Check Appropriate Box)
Purpose of Building Utility Authorization No.a ya 9$ /7
Existing Service ZAU Amps )Z° / ()V b Volts Overhead ❑ Undgrd I I 0 25 ,f Meters
New Service Amps / Volts Overhead❑ Undgrd `o. s l
Number of Feeders and Ampacity 3
Location and Nature of Proposed Electrical Work: Apo 4 Ldp 61243 n as _
Completion of the followingtable maybe waived b ® s.
y
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security 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 if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start:8/6/7 l� Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE O RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
A _ the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office.
(V" El ONE: INSURANCE BOND OTHER (Specify:)
g\�x 0,, I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: -��oc,� 6jr,cc:, LIC.NO.: M n IOW
Licensee: '10 ck. Gj v , i' 7 .IJ Signature 411111111111r> LIC.NO.: Ea3-9/9
(If applicable, enjjer "ex pt"in the license number line.) Bus.Tel.No.: 974-Y19 ass
Address: r2 Co JOAml l� DK S'Z lir-XIDij . e,P•(y Alt.Tel.No.:
*Per M.G.L. c. 147,s.57-61,security work quires 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)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
IMPORTANT. A sanarata narmit is rani iirari fnr tha inctallatinn of cmnka Aatactnrc Firp Alarm incnartinnc ara narfnrmarl by the FIl havinn ii iricriirfinn