HomeMy WebLinkAboutBLDE-23-15917 5/23/23,6:57 AM about:blank
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ELECTRICAL PERMIT ,TM
Job Address: 15 WILFIN RD Unit:
Owner Name: OUIMET JAMES J OUIMET GAIL M
Owner's Address: 28 SOUTH ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15917
Existing Service Amps/Volts Overhead 0 Underground 0 No.of Meters:
New Service Amps/Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Permit to close out old permit.
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool: In-Grnd.0 Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: May 23, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: RICHARD J ROSAZZA License Number: 15610
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number: `4-
(3-975—c9 9
Address: GRANBY, MA, 010339758 GRANBY MA 010339758
Email: rickrosazza@comcast.net Business Telephone: 413-313-3922
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.
INSURANCE:
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Commonwealth of Massachusetts Official Use o
Permit No.: �Z—5 `I (
-; Department of Fire Services Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
1 �/,�All work to be performed in ac ork�nj�ce with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: / O /A9rv-et�y Date: 340%3
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
j Location(Street&Number): /. iv,/4/�/ /1 o14 ci Unit No.:
C Owner or Tenant: (,4'9P1 I L w t rvt el- Email:
Owner's Address: Phone No.: ! /3- 6-7 '8-1)'
Is this permit in conjunction with a building permit?(Check appropriate box) Yes 21 No ❑Permit No.:
Purpose of Building: Utility Authorization No.:
UExisting Service: a O G Amps Mot a(O Volts Overhead 0 Underground, ] No. of Meters: 1
v New Service: Amps / -Volts Overhead El Underground❑ No.of Meters:
Description of Proposed Electrical Installation: f ( t- 14 (• Trts?_, c4%Ox --S U� E `'edit cA}�'
) &..� 'Pe.e-- o €c. .
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:
C. No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
• No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
, Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
y No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start:_. _ sp. _ions to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME OSA 22 A .6-,`ec4r't c-A-(--- A-1 0 or C-1 0 LIC.No.: Lf/0 04/
Master/Systems Licensee: }9 t r prrd RUS42 a A LIC.No.: /577/U741"
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: a-S Tromp - �U - t F3rosi4.. I \F . 010 3 3
Email: Telephone No.: 11/3 3/3 31�.�� Cam'L C
h t j c �`c�S t -LL r�4-tom+ C O Vv e !A-3 4-. H p
lc ertify, under he pains and penalties of that the i ormation on this lication is true and complete.
Lice se -- Print Name: ��-' c�4 S - Cell.No.:y/..? .34?-2, 4:a -.—.
INSU CE C � less waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of s e to the permit issuing office.
CHECK ONE: INSURANCE BOND ID ❑ Specify:
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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: