HomeMy WebLinkAboutMiscellaneous - 93 ROCKY BROOK ROAD 4/30/2018 (11)The Commonwealth of MassachusettsDepartment of hiblie Se try
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BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200
1/90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (�
All wrk to be performed In accordance erith ch Maauth
s users EJectrkal Code. S27 CMR 12..00 e�
(PLEASE PRXNT xN nm OR =1: ALL INFORtimoN) Date 3 �7 / 7 "
City or Town of /'U- /�i�c�l/ F �/j To the Inspector of Wires:
The unc•rsigned applies for a permit to perform the electrical work described flow.
Location (Street 6 Number)
Otiner or Tenant_
061ner's Address
Is this permit in conjunction with a building permit: Yes No ❑
(Check Appropriate Box)
.. K*rpose of Building i v cif �*, , �/ 6v7//-: tility Authorization NO.
ixiscing Ser. ice ZOG Amps /fir/ / d Volts Overiicad ^ —�
tJ Und ' d �o, of .jettts
New Service Amps / Volts Overbcad ❑
Undgrd ❑ No. of Meters
Number of Feeders and Amnnetry
Location and Nature of proposed Electrical Work
No. of Lighting outlets
':o. of Lighting Fixtures
No. of Receptacle Outlets
No. of Switch Outlets
No. of Ranges
Nc of Disposals
.40. of Dishwashers
No. of Dryers
No. of Water nesters KW
No. Hydro Massage Tubs
0'I,�[ER:
/�fl `7
No. of Hot Tubs
Swimming PoolAbove M
srnd. LJI
No. of Oil Burners
ao'
No. of Transformers Total
11NA
Generators IVA
No. of FErcenev Lteht•tne
No. of Cas Burners
FIRE ALMWS No. of Zones
No. of Air Cond. Total
tons
No. of Detection and
No. of Heat Toul
Initiating Devices
1,1=Toul
s Tons KW
No. of Sounding Devices
Space/Area Heating KW
Ho. of Self Contained
Detection/Sounding Devices
Heating Devices lac _
Local [ Municipal ❑Other
Connection
No, of o. o
Si s Ballasts
Low Voltage
Wirin
No. of Motors Total HP
INSURANCE COVERACE: pursuant to the requirements of fUscachusetts Central Lava
I have a current Li t Insuran
equivalent. YES cc policy including Completed Operations Coverage or its substantial
NO I have submitted valid proof of $
ame to this office. YES B -AN -e-
Ii you have checked -Mi please indicate the type of coverage by checking the appropriate box.
INSURANCE BOND ❑ MMM 0 (please Specify)
Estimated Value of Electrical Work $ pirstion ate
Work to Start . ? 1;! 7 Inspection Date Requested: hough/,/•:// C°%-`GFinal
Signed under the penalties of perjury:
FIRM PU
LIC.. N0. J�3�
Licensee
_ gnature. LIC. N0.
Address� i /rdr c s_ .�'-; r �� 'may
/yam/�- Bus. Tel. No. 2�-
OWiT'S INSURANCE WAIVER: I am aware that the Licensee does tot have the Alt�Inssur Insurance coverage or to suD-
stantlal equivalent as required by liassachusetts General vs�.a Rac say signature on this permit
application waives this requirement. Owner Agent (please check one)
Telephone No, FERMI? FF]: S
Signature of Owner or Agent