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HomeMy WebLinkAboutBLDE-26-703 poi • A, F $ v! fgmmnonwealth of Massachusetts Permit No.: ../Use7 ©/2 4 _ ,' Department of Fire Services Occupancy and Fee Checked. ' BOARD F FIRE PREVENTION REGULATIONS [Rev.I/2023] -"' -APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ali work to be pd{f med in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 �tty o Irown of - (ARMOUTH Date: To the Inspector of Wires:By this applicalign,the undf rsigned gives notices of is or her intention to perform the electrical work qescribidtiow.`I Location(Street& umber): /5 6 AP 0✓ `1, ..i ' Unit No.: -s' V 1 t Y Owner or Tenant: I-P A e,\5 1-IR1 A� ✓°t•Lt, ,cc_t.12t E ail: AA'I c-k Z. f- ^C�`'T I M'A\l Owner's Address: `j 7 '---4r Phone No. ��' 'f-3 - v Is this permit in conjunctio with a building pe it7(Oheck appropriate box)Yes❑ No 2lfrmit No.: Purpose of Building: .,,' ••-,tA -01[G Utility Authorizationi No.: Existing Service: /(/ ) Amps -2---- ) Volts Overhead El Underground Ly-w No.of Meters: New Service: Amps / Volts Overhead❑ Underground El No.of Meters:t_ _ Description of Proposed Electrical Installation: 1541 IA ..t-J -L,t I P L/ - C.(�5-,.�( (-1` k i- I2 E 62- & \,- &-LAt.3 5-4-L +z i/k,( ,C`Y411— Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: No,Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices: Swimming Pool:In-Grad.0 Above-Grad.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1❑ Level 2 0 Level 3❑ Rating: OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy) Date Work to Start: 61/1 t ( +_'�4cInspec i to a requ estedi accordance with MEC Rule 10,and upon completion. FIRM NAME: !,�/C `j \` t c Z v I ql A_1❑or C-1❑LIC.No.: Master/Systems Licensee: /19q p I LTC.No.: Journeyman Licensee: Z y I [ Iv . • LIC.No.: Security System Business requires a Division of Occupational Liccnsure"S"LIC. S-LIC.No.: Address: ite F Email: ' Telephone No.: I certify,under the pains and penalties of perjury,teat the information on this application is true and complete. Licensee: Print Name: Cell.No.: INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability 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 0 OTHER 0 Specify: 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 0 Owner's agent 0 Owner/Agent: Tel.No.: Signature: t,A,, ,"D:. ���/ _ Email.: trlitr li..trv7I S`- e)/1C/eirrfl