HomeMy WebLinkAboutBLDE-25-1479 RE C E I 1 Commonwealth, o//r/a±aachu:ietli Ot'ficia!
- t � t t I Permit Vo.
� ¢�av men ol ire Service9 i �
NOV 0 4 �14_�=f=/fa Occupancy and Fee Checked
<h BOARD OF FIRE PREVENTION REGULATIONS
[Rev. 1.07] (leave blank)
BUILD , •c - 4r" _ (CATION FOR PERMIT TO PERFORM ELECTRICAL WORK
By _. . AN work to he performed in accordance with die Massachusetts Electrical Code(iv1EC).52?CMR 12 00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4/0 v. %/ 2.0 2 S
City or Town of: _IA� U-r fJ 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) 7 4£ RT'� / A l/A0,Mo. wp
-/ SQ ! T d gT Map Parcel#
Owner or Tenant '2�[v
i__,A Iv10; Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes I No I kl (Check Appropriate Box)
Purpose of Building D 1,../ ///A/6— Utility Authorization No.
Existing Service Amps / Volts Overhead I I Undgrd C No.of!Meters
New Service Amps / Volts Overhead I I Undgrd I I
No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (,ey to 6.e. /LlR7-o
Completion of the following table 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- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners i 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. Tons I No. of Alerting Devices
No. of Waste Disposers Heat Pump Number Tons KW 1No. of Self-Contained
Totals: 1 Detection/Alerting Devices I
No. of Dishwashers Space/Area Heating KW Local El Municipal
Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No. of Water No. of No.of
Heaters KW Data Wiring:
Sims Ballasts No.of Devices or Equivalent
E No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
O OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires
Estimated Value of Electrical Work:' 0 0 0.0 0 (When required by municipal policy.)
d Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
O) INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licenseeprovidesproof of liability including"
insurancecompleted 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,I BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:6 s C/e_C,,Trsi(1-ct./ Con•Tra-C:r0rs, .... / O.:4/7/.7
co Licensee:ART
Ht/( P Pu) e,r-T Tr Signature/ 7 J - �i• 0.:
it applicable,enter "exempt"in the license azhnber line.) '.us. el.No.:
Address:372_ Pi(yiO'Tt1 R.D f yAki,�,,s y/Vr�. OZ.‘01 Alt.Tel.No.:.5- 77� 009
`Per M.G.L.c. r47,s.57-61,security work requires Department of Public Safety "S" License: Lic.No. '
f) OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
C.-_‘--
......- required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner
Owner/Agent ❑owner's a ent.
Signature Telephone No. PERMIT FEE:$
* IMPORTANT:A separate permit is required for the installation of smoke detectors Fire Alarm inspections are performed oy the FD^di.,,�;urisdictior