HomeMy WebLinkAboutMiscellaneous - 140 HICKORY HILL ROAD 4/30/2018 (11) r
C'ommonwea&of Mamac4ujelb Official Use Only
Permit No. 17?6 r— '
�epalment o���se,�� .
%VJBOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev. 11071 (keaveblank
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 PRCNTININKOR E L INFORM�ITONJ Date-,.20C..N
City or Town of-. or Al)S/1UG%2 To the InspeWor 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 TenantL��r4 �/ ��_;� Telephone No. � / LIZ-6-3
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building /�' (;�� Utility Authorization No.
Existing Service Amps / 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:
Completion o the ollowin table mEX be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total 11-�
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming PoolAbove ❑ In- Elo.o mergency Lighting
d. d. B!Yea Units
No,of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Q
No.of'Switches No.of Gas Burners / o.o election and
42 Initiating Devices
No.of Ranges No.of Air Cond. Tons No,of Alerting Devices
No.of Waste Disposers eat Pump I Number Tonso.o e -Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ unicipal ❑ �,
Co
nnection
Oth
No.of Dryers Heating Appliances KW Security f Dior Equivalent
No.
No.of Water of o,a
Heaters KW Si s Ballasts Da a Wiring:
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP I eletommunitations Wiring:
No.of Devices or Equivalent
OTHER:
����i�� Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: —e — ..L_ (When required by municipal policy.)
Work to Stare Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE VERAGE: Unless waived by the owner,no permit for the erformance of electrical work
. P o may issue unless
ess
the licensee provides proof of liability insurance including"completed opetatiod'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 BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and AhIdes of perjury,that the information on this application is true
PP and coin le
p te.
FIRMNAME: Aries Electrical Service and Controls LLC LIC.N025650a _
Licensee: Nor and Michaud Signa .r _ _ _ .IC.NO.: 4�e
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:_ A'D R h R 7 0544
Address: 290 Broadwav suite 117 Methuen ma 01844 AIt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityin u
required by law. By my signature below,I herebywaive this r s ranee coverage normally
Owner/Agent requirement. I am the{check one El owner ❑owner's a env.
Signature Telephone No. PERMIT FEE: $ -