HomeMy WebLinkAboutState of MA electrial insp formA
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Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Registration of Gosmetology and Barbering
1000 Washington Street, Suite 71 0, Boston, MA 021 1 I
617-701-8792
Electrical lnspection Form
INSTRUCTIONS: This form should be completed only if electrical work has becn
done in the shop after purchase.
Date: glslzA
This is to certifu that I am an Electricel Inspector for
alterations or installations for:
, and that the electrical
Name of cily ot town
Name ofShop Applicant
461 ?n,t * 7-9
Streel Number Steet Nqme
o
dte
is in accordance with the specifications ofth€ stat6 electrical code found at 527 CM&
p.-)
ame olCity or Town Shop k Located
Name of Elecfical Contractor
License #
Exp. Date
Address
€u* Co.,-*^
tjN Ca"u-e
No. Street
Signed 0//
Electricql Inspeclot License 4
Ciry
r
5G8Qa- 9
7-?t- z(
a 6'/-0
Citv/Town
a/-
Erp. D
RECEIVED
sEP 0e 202r
BUILDING DE PARIM E NT
Revised Dec 2021
oz/-73