HomeMy WebLinkAboutBLDE-24-138 - //,,� �/i / Official Use Only Q
commonwraUlr a////meachusrfts t c'�38::::.e, �rparfmrnt/�' nPermit No,t'w rra cr!is
' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/07] (leave blank)
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: 7/3/ZN
City or Town of: Vase rvt ooiM 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) 32 'Dta na P(v._
s� Owner or Tenant L-O 'C (.. TV I I.cork Telephone No. 7'7 y-2I -S9°9
Owner's Address 32 t\QY\! MI{
Is this permit in conjunction with a building permit? Yes ❑ No IN (Check Appropriate Box)
Purpose of Building P1{.9\tl,rlh-'ta,\ Utility Authorization No.
�i Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
041 041 New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
E! Number of Feeders and Ampacity
Gi
cl Location and Nature of Proposed Electrical Work: plate,., Z sugils ih yoon,, , C hwicte bca..
•, %V\ rsov o jc., Prod ty f rts(ikt.topilat nv\ rItt,IC i let_plmfl Z.tiwl-errs r LTs,C1'wvet a E tc
v) Completion of the following table may be waived by the In vector of Wires.s re_to. �
Si No.of Recessed Luminaires No.of Ceii.Susp.(Paddle)Fans Transformers No.or
Total KVA "
'CIA thokN.
t No.of Luminaire Outlets No.of Hot Tubs Generators
KVA
No.of Luminaires Swimming Pool Above ❑ ❑ No.0 a EmergencynitsLighting
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.Inetentioe an R (� �- I v
f Dating De ale
No.of Ranges No.of Air Cond. Too i No.of Alerting Devi �
No.of Waste DisposersHeat Pump Number Tons KW No.of Self-Contained JUL U 3/024
Totab: _._.__........__...._.___..__..__ Detection/Alertin
No.of Dishwashers Space/Area Heating KW Local❑Municipal
Connection I(:flli1'G DEPF RTMENT
No.of Dryers Heating Appliances KW Security Systems:` - —
No.of Water No.of No.of No. vices orTquivalrnt
KW
Heaters
Data Wiring:
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: �D/DD D (When required by municipal policy.)
Work to Start: 'Mkt 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 ® BOND 0 OTHER❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: C..littft53apissc Moo-M t LIC.NO.: cizco-a
Licensee: C�y s.,eh y 1\41,,.Vl44 Signature � .2''' _ LIC.NO.: 51 2 SO-g
lif applicable,enter"exempt"in the license mmsber line.) Bus.TeL No.• T-I'1-QO)
Address: SG nld puck NiA.e (toad/ Ortee.r\s, MA o2(ori3 Alt.TeLNo.: -9B77
'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)❑owner 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:.