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Home My WebLink AboutE-08-145APPLICATION FOR PERMIT TO PERFORM ELECTRiCA~ woRrc All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 ~~ ~ ~®~ ~ (OFFICE USE ONLY) TO H By AUG 1 3 2007 Fee: ~ ~~~ ~''~~ /1 ~ ~,1J ~~ ~ ~ PERMIT NO. ~ r~ ~ `7 S ~~~~~,~~~ oFr~T. 3 ~~ __ i (PLEASE PRINT IN INK O N) Date: ~'!~ ~ ~ ~ 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 & Owner or Owner's Address ~~~ a-y ~-~.rc~- ,~/' Is this permit in conjunction with a building permit? ~ Yes L~No (Check Appropriate Box) Purpose of Building Utility Authorization No. /~ ~ ~S8 Existing Service / 0 ~ Amps 1 ~ / ~ ~oVolts 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: /eiC~,/1t~ ~,,Ltt.~/ /GCS ~t,/7"h,~•v~e., ~-a.. Completion of the_following table maybe waived by the Inspector ofWires No. of Recessed Fixtures No. of Ceil.-Sus .Paddle Fans No. of Total Transformers KVA No. of Li htin Outlets No. of Hot Tubs Generators KVA No. of Li htin Fixtures Above In- Swimmin Pool rnd. ~ rnd. ~ No. of Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detecrion and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number - - Tons - - KW - - No. of Self-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal ~ Other Local ~ Connection No. of D ers ry Heatin A liances KW g pp Secutity Systems: No. of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. ~Y \ INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides V 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 a permit issuing office. CHECK ONE: INSURANCE BOND ~ OTHER (Specify:) ~ '' ~ / - d (Expiration Date) Estimated Value of Electrical Work: ~' 0~ (When required by municipal policy.) 1 Work to Start: g'/3 - a ~ Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th ains and pe lties of perjury, at the i ormation n this a~'plication is true and complete. FIRM NAME: ~/`~~ ~~ CD.v~ss- LIC. NO. 1 S {j 8 8 Licensee: ..- Signature LIC. NO. / c'S a (If applica e enter ~"fie t" in th license numb line.) ~~ jj // Bus. Tel. No.: ~Og - ~'6 ~ 3 ~1'/ Address: ~~ s~ ~ cS©~ Y/il!i _ Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee dyes 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 Signature Telephone No. [Rev. 04/00]