HomeMy WebLinkAboutE-10-323 Unit 7 Electrical Permits0 A
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BOARD OF FIRE PREVENTION REGULATIONS
Official Use On��ll7y��
Permit No. (` � ) o '3 L_.,.J
Occupancy and Fee Checked
[Rev. 1/071 (leave bland
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK`ECT
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: J C11 / % � ''
City or Town of. j" l To the Inspector of Wire- 8
By this application the undersigned gives notice of his or her intention to perform the electrical work descn ow.
Location (Street & Number) (4c. ,- It- -7 1 ?- I Cam,., V) S, , t
Owner er3ksast
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Bog)
Purpose of Building S i" G rr tQ4,,, t I , Utility Authorization No. /All 4
Existing Service O Amps c%Volts 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:
F-1 k f/it 4t I-i- 1 I J.ecrc ,c - t
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
o. of 7otal
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators K'VA
No. of Luminaires
Swimming Pool Above ❑ n- ❑
rnd. rnd.
o,o Emergency Ug ng
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
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Totals:
I NumLber
I Tons
IKW
No. of Self -Contained
Detection/Alerting Devices
—
-
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
ecunty Systems:*
No. of Devices or Equivalent
No. of Water,
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wirin
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: S (When required by municipal policy.)
Work to Start: %Gf blc ( Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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 ge is in force, and has exhibited proof of same to the permit issuing office.
7BOCHECK ONE: INSURANCEND ❑ OTHER ❑ (Specify:)
I certify, under the pains a d penalties of perjury, that the information on this application is true and complete.
FIRM NAME: W, A o�. L;c /- (,mac t. c / 1n /I LIC. NO. A / 4 V
Licensee: 6. I i t �, . ` S c%r � � c Signature s .- LIC. NO.:
(ifapplicable,anler "exem ff ' in the license number line.). Bus. Tel. No.: t y
Address: �` N. �f„ `f �, (� t c Lt /Vl v �>7 Alt Tel. No.:S S --79? 31 Lf
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
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 PERMIT FEE. $
Signature Telephone No.