HomeMy WebLinkAboutBlanket Electrical Permit for 2019 - Permits - 315 TURNPIKE STREET 3/13/2019 Commonwealth of Massachusetts Official Use Only
Department of Fire Services Pormit No. 7(o,2 6�
BOARD OF FIRE PREVENTION REGULATIONS Pornlit Fee Assigned 0' 01>10- 1__DL
(Rev. 11/99) have blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
FOR INSTITUTIONAL* USE ONLY
This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the
municipal Inspector of Wires is required for work on the premises of the institution, if you are not an employing institution
pursuant to C. 141 §8 of the Massachusetts General Laws,stop here, You cannot use this form. Use the standard form only.
(]'LEASE, PRIINJAW OR TYPrT ALL INIZORAMTY N) Mite
City orb:[own of: To the InsI)edor qj'kire'v.'
By this application the undersigned gives notice of ill e on-prernises perlbrinance of electrical work by employees.
'.2
Address
Location an()Nature of Proposed Electrical Work:
NOTE, C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical "installations to give notice of
same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem-
plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work,
which shall be exhibited to the Inspector of Wires during normal business hours without advance notice, Some municipali-
ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude.
We will file this forni oil each such occasion(check one): YES 0 NO [I
o We will maintain one or more contemporaneous log(s) (check one): YES El NO -A
This option is available where so contemplated by the municipality, In those cases, you must renew this application annually,
and upon significant changes in employment,
The following individual(s)will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s)will be
located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with
the Inspector of Wires.
Attach saeplalenuentauy sheets iCrequLi a),additional LcW locafl
Log required —tons,
_!�qy�xagej uid location where It will be maintained Responsible let-soil
_a
You may,maintail)the logs electronically upon agreement with the Inspector of Wires, If you intend to apply for such a proce-
dure,indicate below how the Inspector of Wires should access the log:
How many clectriciansand/or system technicians(as licensed by the Board of State Examiners of E.lectricians)do you employ
at your fac
ility? Indicate the total number and also indicate the number of full-time equivalent sta ff that nu inber includes:
Total electrical employment: Full-time equivalent electrical employment:
lJow many helpers,or apprentices do you employ to assist your licensed staff under their direct SUIXI'ViSi011(see c, 141 §8)? 111
general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap-
ply for veterans (see St. 1962,c. 582 §3 as amended by St. 1979,G. 156). Indicate the total numbor and also indicate the until-
ber of full-time equivalent staff that number includes:
Total electrical ein ployin exit: Full-time equivalent clectrical employment.-
Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. I-low
many Such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the
iminber of full-time equivalent staff that number includes:
Total electrical employment: Full-time equivalent electrical employment:
*Insillittlon.y are defined for these pun poses(is any person firm, or coiporation operating 1117der a 141§8,
(Please see reverse side for certifications oil(]reouired sitmature.)
Institutional Permit Form,page
NOM: Some institutions enter into contracts with contractors to porforni ongoing electrical work at an institution, similar
to institutional employees, If, by the terms of such a contract, you direct the performance of such work, include the num-
bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less
than one year, application must be made by the contractor on the standard form for such work. Do not include such ern-
ployces in this application.
Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities"of equivalent. In addition,
provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prornis-
es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au-
thority to direct any licensee of the Board of State Exarnhiers of Electricians to perform work in contravention of the rules of
said Board, or in contravention oft
)Massachusetts Electrical Code,
My title is: e i/�_'/t-2,xt
My authority to act for the aforementioned institution is:
I ceriol,raider the pains andpanuffles ofteiJuiy,that ilia Information ou this ty)pficatio)i tv fare and complete.
(Signature) (Dated) 311�/
(work telephone number) (extension) (facsimile number)