HomeMy WebLinkAboutBLDE-24-1036- Comnoew.atfh e f ccar a te�a�ichiredte Official�U{se Only
•! 1J.parlmant./.1in S erica Permit No. l/v"1 --I�Q
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/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
1.
(PLEASE PRINT IN INK OR TYPE L INFORMATION) Date: f 3/A a aY
i,- City or Town of: /M AIO UP/ To the Inspector/of Wires:
By this application the undersigned es notice of his or her intention to perform the electrical work described below.
eLocation(Street&Number) -7 C Rl Sr ✓A// Wed r )f!/,eIYIO�7/
� Owner or Tenant C//'I S 719Pele- Co/Qman Telephone/ No.
,J Owner's Address y o2 Ft•,y (_N ,(jAri'.• h-i /1ST-0 22 eel
(ad Is this permit in conjunctiva with a permit? Yes ❑ No CAI (Check Appropriate Box)
Purpose of Building hi-0 7' "V U utborization No.
ci Existing Service /L/8 Amps /16! ,2)'V Votb Overhead[ Undgrd❑ No.of Meters /
cj New Service Amps I Volts Overhead El Undgrd❑ No.of Meters
Number of Feeders and Ampacity
f Location and Nature of Proposed Electrical Work: /!e Q AM /!-Coi r 7D
Completion of thefollowbrgtable may be waived by the Inspector of Wires.
lb No.of Recessed Luminaires No.of CAFans No.of Total
Cell-Soap.(Paddle) Transformers KVA
S KVA
CI No.of Luminaire Outlets No.of Hot Tubs Generators
Above In- No.of Emergency Lighting
k No.of Lamlaaires Swimming Pool grad ❑ t d. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS
D
No.ofDetecdon a - ' -- VF
No.of Switches No.of Cu Burgers -— —
Initiating Devic
No.of Ranges No.of Air Coed. Ton' No.of Alerting Jul 0 2n
No.of Waste Disposers HeatTotals: Number Toes ..--KW No.Det ocoon/ie i
I
No.of Dishwashers Space/Area Heating KW Local 0 Conn Man UIF"UtHAK i MENT
--- .-_
Secu
No.of Dryers Heating Appliances KW Systems:
of or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent�
Telecommunications i
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent
OTHER:
D Attach additional detail(((desired or as required by the Inspector of Wires.
Estimated Value of 1 cal Work: O (When required by municipal policy.)
Work to Start: 7 v7 it 2 V Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: Unless 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 cov a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
I certify,under the pains/turd penalties of perjury,that the information on this application is true and complete ,4 G„
FIRM NAME: Nt -' / 5C/10?Al,- e LIC.NO.: %7 7
Licensee: Signature ).Z ,* LIC.NO.: Dr
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No. �y-7 `/o`�
Address: Alt 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)❑owner 0 owner's agent.
Owner/AgentPERMIT FEE:$
Signature Telephone No.