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Home My WebLink AboutE-08-071M 1` A ,�t commonwo,J14 Of r//amaCt>S Uj 2,parfinent of Sin S.,k , OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. E-07- 0 @9/ Occupancy and Fee Checked [Rev. 1/071 leave blank ALU ATION FOR PERMIT TO PERFORM ELECTRICAL WORK 11 work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12,00 1 E PR11Y IN INK OR TYPE ALL INFORMA !ON) Date: City or Town of: To the Inspector of Wires: By this application the undersigneolgives notice of his or her intention tooperform the electrical work described below. Location (Street &Number) a 9 N t G i1 %7� i14 � e J -ll(t- Owner or Tenant Deceevt t t oto U Telephone No. Owner's Address Is this permit In conjunction with permit? Yes No ❑ (Check Appropriate Boz) t,,b.ulIdlng Purpose of Building �� iPcf Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ramnletinn mike &IInwino tahle may he waiver/ by the InsOector of Wires. No. of Recessed Luminaires No. of Cell. -Sus P (Paddle) addle) Fans o, n ora Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above ❑ °' ❑ rnd. roti. o. o Units Emergency Lighting Bette Units No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o e ec on ncl Initiating Devices No. of Ranges al No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers carr imlp um er ons Detection/AlertingtalnDevices of Dishwashers Space/Area Heating KW ❑ Municipal ❑OtherNo. Local Connection No. of Dryers Heating Appliances KW Sy- uri a No. f Devices or Equivalent No. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a No. of Devices or E uivalent OTHER: Attach aaaitionat actor/ 1J aesireq or as requires Dy the Inspector of mires. hhrnatcd Value of Electrical Work: ��, //� (When required by municipal policy.) Work to Start: Z:2:L/" (1% 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 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] BOND ❑ OTHER ❑ (Specify:) I certify, under the pains nd penaltie of er)ury, that the lnformalion this is true and complete. (� FIRM NAME: e C / LIC. NO.: ) f 6-.2 Licensee �t(�,vtr�� SU �� )IjwSignatu LIC. NO.: applicable, enter "exempt" in the lice numb iine.)s / Bus. Tel. No.: `X r -O r6>� Address: 6 Q l' / Alt Tel. No.: Ci *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, l hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. T Owner/Agent s,% Signature Telephone No. PERMIT FEE. $ .0 JUL IL By -`t Coavnonwaa& 0/ l mac"Mj Apar&wnt o/-7im S Siwe OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. E —O F' 01?/ Occupancy and Fee Checked [Rev. 1/071 leave blank) ATION FOR PERMIT TO PERFORM ELECTRICAL WORK G ll work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 L�ASEPBIIY IN INK OR TYPE ALL INFORAM ION) Date: �7-- �.5� —0 7 City or Town of: To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) hG h L 7-7 0; (!Z 1 IC et t - Owner or Tenant QeC_e eA S 100, U Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building 'ufJP y No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �F2-l11rs�Y �Jyl�it� e r/o//1 r lAIALSo c'.- lii I � r �,. ) .r,vi,.�H -- Tr iL-7-tV —'7Z -,-- r/ Com letion o the ollowin table maybe waived bX the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o, of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires ove M in -0o. Swimming Pool rnd. rnd. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: ,,.,, nm,. er ons '- o, oSelf-Contained Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑ Other, Cyyonnection No. of Dryers Heating Appliances KW ri No. f Devices or Equivalent. No. of Water KW o. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP el ecommunications tiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. ated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: Z�-07 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 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] BOND ❑ OTHER ❑ (Specify:) I certify, under the pains nd penaltie of erjury, that the information this is true and complete. FIRM NAM 0 1 E� LIC. NO.: Licenseec�Ci(l2ytj St) 1) )U� Signatu LIC. NO.: �(If applicable, »ter "exempt" in the licelM numb line.) /' Bus. Tel. No.: Address: e6E 4P , Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $