HomeMy WebLinkAboutMiscellaneous - 792 WAVERLY ROAD 4/30/2018m Z
0
z
0
z
z O
0
m
X
\ Gommonwealtn of massacnuseus
- - --- Department of Fire Services Permit No. WIZ -
BOARD
IZ-
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/99] leave blank
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 TYPE ALL INFORMATION) Date: /o� (.� 6
City or Town of: Iyon th n 0'U V G /2 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) ,See eoe
7—
Owner
Owner or Tenant P?/Ge. 1ti0 j 2Telephone No.
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building e�1,4/,/ Jf /0c--
Existing Service Amps / Volts
*A,,7i M --) 0� y
Yes ❑ No ❑ (Check Appropriate Box)
Utility Authorization No.
Overhead ❑ Undgrd ❑ No. of Meters
�OD Amps j,%c7 /�° Volts Overhead❑ Und rd �^ <
New Service g No. of Meters
Number of. Feeders and Ampacity
Location and Nature of Proposed 1 ----Electrical Work: �'��.�i�!/7'
Completion o the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
t� -
Swimmin Pool Above ❑ 'n -d.
rnd. rn
o. o mergency tg tng
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
JNo. of Zones
No. of Switches
No. of Gas Burners
Detection and
No. In
nitiatin Devices
No. of Ranges
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals :
I.Number
... .. .....
Tons
..........._..........................
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KWLocal
❑Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
SecurityNoof DevSteices or Equivalent
No. of Water KW
Heaters
No. of No. of
Sions Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector o/ Wire..
INSUPANCE 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 to the permit issuing office.
CHECK ONE: INSURANCE N BO El OTHER E] (Specify:) Dowling Insurance Agency 5/9/07
(Expiration Date)
Estimated Value of Electrical Work: 000 (When required by municipal policy.)
Work to Start: l Q� Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the p afns and pen allies of perjury, that the' orma on on this application is true and complete.
FIRM NAME: AVERILL ELECTRIC CO. INC. /�� A LIC. NO.: 15567 A
Licensee: Francis M. Averill SignaLIC. NO.: 15567 A _
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-963-3698
Address: 17 Techincal Park Drive, Holbrook Ma, 02343 Alt. Tel. 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
Signature Telephone No. [PERMIT FEE: $
1