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HomeMy WebLinkAboutBLDE-24-1242 kj6 L_orrnor-wca of Ma.e.6acAV-Sc ' Ocia1 Use Only Permit —`2j4Z2c .-„rrt of.}tie Jc v/oc6! -- a� ' Occupancy and Fee Checked -_ BOARD OF FIRE PREVENTION REGULATIONS jRev. 1/07] (leave blank) . APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed i-h accorrnce with the Massachusetts EIeco-ical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF ORIef4TION) Date: 1" - 30 7,4 City or Town of: Y RMOUTH To the Inspector of Wires: this application the l,nde7imed gives notice of is or her interon to perform the elect-icai work described below. ® ) g�'0..2.: n �L' anon (Street&Number 7_ G�� LP N :'O error Tenant CSC \_..4_ v`.t.....(2, e__Ni R.- --It. IOvZt{ Telephone No. %i R t N 2O er's Address ,S f4c41© co GIs his permit in conjunction with building permit? Yes ❑ No } (Check Appropria B x) —IDPpose of Building E -0 �7c. StoUK'Z, Utility Authorization No. i IN)--- JErtsting Serr�ice.3?-,r,)Amps 1)-A) /a,40Volts Overhead Undgrd E-- No. of Meters I ce*---.-.]NA,Service Amps / Volts Overhead E Undgrd ❑ No. of Meters ber of Feeders and Ampacity Ste)me x a-L) Location and Nature of Proposed Electrical Work: 1'f-'-5.T.P.-fi 7� P(.2`. L�z�S i O tR) 1�-t,� 1 .k.`Zo C ko `Ai-A-c(o6v vt k 6-1,6“2k1,S Completion of the following,table may be waived by the Inspector of Wires. INo. of Recessed Luminaires LNo.of Cell.-Susp.(Paddle)Fans No.of Total Transformers `oIo.of Luminaire Outlets No.of Hot Tubs Generators KVA No.• o - tninaires ,Swimming Pool Above In- ❑ No.of n:merc Lighting flrnd. Li _rnd Battery II No. of Receptacle . - its No.of Oil Burners IFI33E�4I.ARMS No.of Zones No.of Switches :..of Gas Burners o.of Detection and • Initiating Devices No. of Ranges No.. of Air . . • To s No.of Alerting Devices No.of Waste Disposers Heat Pump Number KW INo.of Self-Contained Totals: Detection/Alertin:Devices No. of Dishwashers Space/Area . sting KW ❑ Municipal ❑ O �' Connection ther No.of Dryers Hea Appliances Sec , stems:" No.of k :ces or Equivalent No. of Water of Heaters No.of IData Wiring: - (�(^ Signs Ballasts j No.of Devices or Equivalent l No. Hydromassage Bathtubs No.of Motors Total HP !Telecommunications Wiring: No.of Devices or Equivalent j OTHER: - o c, Attach additional detail if desired or as required by the Inspector of Wires. (3Estimated Value of Electrical Work: tTlO0 (When required by municipal policy) 3 Work to Start: Inspections to be requested in accorrIPnce 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 %Jl the licersee 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 (g BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. 3 FIRM NAME: �. L L, ),,--,Q0- �kskt �.� LIC.NO.: S. I .1 ,,/ � Z Licensee: a. - 1,.1 +.:k.(c, Signature _` `d� 3 (If applicabl enter "exempt"in the license n•tuber line.) / LIC.NO. . Address: COL- "I,Z �' 0D us„) . N fq f...R'f.,t M far ‘ O�.6o6c1 Bus.Tel.No.: 6 - - 77L� t Per M.G.L. c. 147, s.57-61,security work requires Department of Public Safety"S"License: Alt.Tiel.No.: 2 .1z 11 n 4 -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor have the liability insurance coverage n—r ly required by law. By my signature below,I hereby waive this requirement I am the(check one)❑ owner Owner/Agent ❑owner's a enc. �� Signature Telephone No. . PERMIT MUM' , ' ,r