HomeMy WebLinkAboutBLDE-25-1050 t,ommonwea&h oi/Ilaxtacl=a�etti Official Use Only
R E C G i 2epartment o f.tire Serviced
No. >Z� (0 S�
AUG i �_ 80ARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
(Rev.1l07] (leave blank)
BUILDING Dt=,/!►Rll:'i ATION FOR PERMIT TO PERFORM ELECTRICAL WORK
By -_.. __.__. _. All wont to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -(c -2 5-
City or Town of: `61 Crs i. i H 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) ' L IV_ DORE iZO l♦D
Owner or Tenant 11 ANe es)5S Telephone No.
Owner's Address 5 11 m
Is this permit in conjunction with a buildingpermit? Yes
r ❑ No ❑ (Check Appropriate Box)
Purpose of Building S�n.11 e p m Utility Authorization No. 4 I i 5-`) 7
rn
Existing Service (Ot Amps (20/ Zi0 Volts Overhead a Undgrd❑ No.of Meters t
New Service 200 Amps 170 /240 Volts Overhead Q' Undgrd❑ No.of Meters I
Number of Feeders and Ampaclty t S cT `I/0 ALUM X llf M IJ
Location and Nature of Proposed Electrical Work: Set-,((t a OM Io JQ 100 TO 2m • 1.0,;e (a)
1 Mt.1 A/C - NEei Pomp 5'LtT SW STEMS • Ntc,} 1-llndtrC) t CirOv,cirt) t TvCS •
Completion of the followingmble may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming pool Above In- Na.of Emergency Lighting
grnd. LJ grnd Battery Units
J No.of Receptacle Outlets (). ') No.of Oil Burners FIRE ALARMS No.of Zones
'� No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 9. Tuuns 5.S No.of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained�^ No.of Waste Disposers
Z Totals: Detection/Alerting Devices
ci No.of Dishwashers Space/Area Heating KW Local Municipal
'D Connection ���
No.of Heating Appliances security System
No.of Devices or Equivalent
No.of Water No.of No.of Data Wirin
-� Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs Na of Motors Total HP Telecommunications Wiring:
p No.of Devices or Equivalent
OTHER: IZrA➢4 "f0 zt�SPECT . < Oxfe CV,Ly e &n,iL . (O.e
r Attach additional detail if desired,or as required by the Inspector of Wires.
_ Estimated Value of Electrical Work: S,Ow 4/— (When required by municipal policy.)
. Work to Start: g- •--I s- 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
\ten\ 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 [l) BOND 0 OTHER 0 (Specify:)
I certify,under the pain and penalties ofperjuty,that the information on this application is true and complete
FIRM NAME: LIC NO.: Al(.88c9
Licensee: 2odiw C. rev Signature VIANah C. S ,)-ea LIC.NO.: E 3 01 3 b
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.Address: 7'7 MettRiAm, 0;ST. N.0XF0tta MA- 0153`7
*Per M.G.L.c.147,s_57-61,securityworkAlt TeL No.:CO b64 0 72 3
OWNER'S INSURANCE WAIVER:
requires Department of1'ublic Safety"S"License: Lic.No.
RIVER: 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)0 owner 0 owner's agent
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ CT ,