HomeMy WebLinkAboutBLDE-26-704 RECEIVED
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ommonwealth of Massachusetts Permit No.: ef:VO
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=z9�►iaow 1 , I Department of Fire Services Occupancy and Fee Checked:
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N =�;_-�•ky : I) , RP OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
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By - �= a ' ' ICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: hi AMOIrn-J Date:S-- // -24
To the Inspector of res:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): /2 7 W t 2V17 Mai? IAJA Unit No.:
Owner or Tenant:g//G#C - D v L//J(® mail:
yy Owner's Address: ` 2,7 MI WA/L� i Ind A OCJ Phone No4 i?•cac- 77O
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No ET Permit No.:
Purpose of Building: /EsXClr Utility Authorization No.:
Existing Service: /60 Amps//5-/i7.0 Volts Overhead® Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: 1Aj11t AG G g r.>itost 4 A;<...,
Zed,(-4c.t / 4?4 w,P. .- S.-•-hoke- Co
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-Grnd.❑ Above-Gmd.❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1 0 Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: /Fa°r --- (When required by municipal policy)
Date Work to Start: .....1-- g'�a Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: erA. /// (6/"LS 4-ZL• v.-_-7-02I C-- A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee:1-0 D D A . y/4.G. ..A.,S LIC.No.: 4 /3�g
Journeyman Licensee: " LIC.No.: 47-d. g'G .,y
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Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
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Address: 7sg- 0 JtL9s L- ^ , ,4 - G Z.G� 3
Email: /.eb/-7/G.6,,Alj2-Z C—GTJ2< 6 01`I/1-- CcYleOhone No.:S`3Tr vZ 3),C 2. r,..J
I certify,under�theeppa s n lti s of perjury,that the information on this application is true and complete.
Licensee: ^� j� Print Name:TO P.M{ .Hi 4 /I Cell.No.:
INSURANCE COVERAG nless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability i - ding"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 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❑ Owner's agent❑
` Owner/Agent: Tel.No.:
Signature: 0°i%,/ j Email.:
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