HomeMy WebLinkAboutE-09-671 #87 Electrical PermitsAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
T
(PLEASE PRINT IN INK OR
(OFFICE USE ONLY)
By
Fee: $ G �J /
PERMIT NO. C- 0 [ _ 6 J
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 & Number) \�`
Owner or Tenant e & An Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? I Yes 93<- (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Q Amps nG / ((bVolts Overhead Undgrd CA-- No. of Meters
New Service Amps / Volts Overhead Undgrd 71 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: ecz
Comvletion of the followmz table may be waived by the Inspector of Wires
No. of Recessed Fixtures
No. of Ceil.-Sus . Paddle Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above 71 In-
Swimmin Pool gmd. grnd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No, of Waste Disposers
Heat Pump
Totals:
Number
F— —
Tons
KW—
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local 71 Connection Other
No. of Dryers l
Heating Appliances KW
SecSystems:
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. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail tJ desired, or as required by the inspector of wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued 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 [I BOND C1 OTHER (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
,NWork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under he p . s and penalties of perj ry, th t the information on this application is true and comple ^ _
FIRM NAME: _`— , \ C EC, ctC_ LIC. NO. ( �
ZLicensee:�,ZqV CC - (a � e Q ,\C C , r Signature LI ,PTO.
(If applicable, enter "exempt" i the license number lit g�.) Bus. Tel. NUJ
AddressZA p1 �"��ltlf;ne "lc►70� '�ti Alt. Tel. No. 04
OWNER'S INSUUNCE WAIVER: I am aware that the LicenseAdoes nol have the liability insurance coverage normally required by law. By my sign ture
below, I hereby waive this requirement. I am the (check one) owner owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 04/001