HomeMy WebLinkAboutE-07-234 #90 Electrical Permits•
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: Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. cr7 — Z 3 y
It
Occupancy and Fee Checked
111991 ve blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL I
All work to be performed in secorda= with the Massachusetts Electrical Code (MEC), 527 CMR
(PLEMEPRINT IYEX OR =FALL INFORMATION) Date:
City or Town of: YAI MOUTH To the Inspector of R
By this application the undersigned gives notice of his or her intention to perform the electrical work
Location (Street &Number) MILL 'POND VILIAGEr
121 Cm p St E
:d below.
Ala
Owner or Tenant Gatewood Hanes/ Jeff Sollows Telephone N0.508-7799669
Owner's Address .1600 Falmutn Rd., Suite 25, Centerville, Ma. 0263.2
Is this permit in conjunction with a building permit? Yes XC7 No ❑ (Check Appropriate Box)
Purpose of Building single family residence Utility Authorization No.
Existing Service
Amps
/
Volts Overhead ❑
Undgrd ❑
New S�ce
Amps
/
Volts Overhead ❑
Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampat:ity
Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel)
with backup battery centrally monitored
rnnnlciiod of the following table may be waive2l by the Inspector ofWims.
No. of Recessed Fixtures No. of Cel-S . SP. (Paddle) Fans Transformers KVA
No. of Lighting Outlets No. of Hot Tubs Generators KVA
No. of Lighting Fixtures Swimming Pool d e . ❑ In -d. BatteryUnitNo. ot s
Ughting
No. of Receptacle Outlets No. of Oil Burners FIRE.. AT_ARMG .No. of Zones —1
o. o etectron.an 7
Na of Switches No. of Gas Burners Initiating Devices
No. of Ranges I No. of Air Cond. Tons ToiNo. of Alerting Devices
No. of Waste Disposers
--Totals:I
lDetection/AlertingDevices
No. of Dishwashers
Space/Area Heating KW
Municipal
icipti l [N Other
No. of Dryers ..
Illeating Appliances KW
Security f Devices or E ivalent
No. of Water KW
Heaters
o. of No. ot
Si s Ballasts
Data Wiring-.
No. of Devices or E aivalent
No. H drumassa a Bathtubs
y g
No. of Motors Total HP
wing:
Telecommunications .ofDeV es or
No. of Devices or Equivalent
OTHER:
Attach additlawl detail ifdesired. or as repired by fhe Inspector cfW1res
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 tothe permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ O= ❑ (Specify:)
tpuahon to
Estimated Value of Electrical Work $ 750.00 (When required by municipal policy.)
Work to Start: Inspections to. be requested in accordance with NIEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete
FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C
Licensee: Jonas R Bielkevicius Signature LIC. NO.• 499D
(1fapp&able, enter "exempt" in the liceme.nutnk ..rise Bus. Tel. No. • .—.83.3-0996
Address: PO 'Box: ,1609. $ar. : 02563 Alt. Tel. No.* 508-7 —3 7
OWNER'S INSURANCE WAVER .I am aware that the Licensee does not have the liar
required -by law. By my signature below, I hereby waive this requirement I am the .(check
Owner/Agent f
Signature Telephone No. L