HomeMy WebLinkAboutE-11-274 #115 Electrical Permits�s cotnmo,�e�.o`�a�3a<�e�
Official Use Only
cc�� c7 Permit No.
.Clepariment o�.tira �erviees
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPEALL INFORM4TIOA9 Date: q — t 3 --1 d
City or Town of: w es-N- J arnn ru kn - To the Inspector of Wires:
By this application the undersigned gives noticef of his or her intention to perform the electrical work described below.
Location (Street & Number) C wit, p
Owner or Tenant 'l-Inm !la
rvner's Address I Z j C&-vv� P b -I-' " 12- M- 1' 7
this permit in conjunction with a building permit? Yes ❑ No ❑
TelephoneNo. `
(Check Appropriate Box)
of Building Utility Authorization No.
Existing Service
New Service
Amps / Volts
Amps / Volts
Number of Feeders and Ampacity
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
Location and Nature of Proposed Electrical Work: See I. r t� *Lknn
No. of Meters
No. of Meters
rmmnlctinn nfthe fnllnwina table may he waived by the Inspector of Wires_
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
ta
Nl
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ - ❑
g rnd. rnd.
o. oUnits Emergency Lighting
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
and
o. of Initiating Devices
evices
No. of Ranges
No. of Air Cond. Tool
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
I
_
No. of Dishwashers
Space/Area Heating KW
Local ❑ MunicipFl ❑ Other
Connection
No. of Dryers
I y
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
0.0 No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa a Bathtubs
Y g
No. of Motors Total HP
Telecommunications u
No, of Devices or E uivalent
OTHER:
Attach additional detail ffdesirec4 or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: q ( q -(d • 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
(� I the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
�J undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Self Insured
I certify, under the pains and penalties of perjury, that the information on this application is true and complete
L FERMNAME: ADT Security Services Inc. LIC.NO.: C - 4 5
Licensee: Mark A. Brophy Signature _ LIC. NO.: C - 4 5
i- (If applicable, enter "exempt" in the license number line) Bus. Tel. NO.• 7 81- 3 5 5 - 5 619
Address: 410 University Avenue Westwood, MA 02090 Alt.Tel.No.•781-35 -5500
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. • 00953
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: $ '-IS, en
Signature Telephone No.