HomeMy WebLinkAboutElectrical Permit #5171 - Permits #5171 - 131 COTUIT STREET 4/30/2004 9
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ELECTRICAL
ICAL��INSPECTOR
NSPECTOR
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Occupancy and Fee Checked
SOARO OF FIRE PREVENTION REGULATIONS (Rev. 1 ,
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APPLICATION FOR PEOMMIT TO PERFORMELECTRiCAL WORK
A111 work to be perrormcd in accoidmicc with the Nt us tts Icctrical Cody(XI C,527CM
PL E,A SE PRINT "1jVK OR TYPLI A LL hYr#08M.w 701 Date.
City Town, of: &2�� ,. �� Tol the us i-oflo
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this application the und�t�s i ' go i s no(icc �hi r hq r intention. t r" rm the i tr I r described, f i g
Location(Street & jai[ r
Tema Teleplione 9 w "
0wrtier's Address 2,
Is, this permllit,in Conjunction with n buildinq permit? Yes N ol (Clieck Appropriate tv
BPut"pose or Building Lifflity Authorization No.
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�s \1 0 1 Its overliend 0 Undurd 0, No. orMeters
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New Servi+: At t�s �" �colts Nw is n r Now r t r�s
Nuniber or Feeders and Ampacity
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Location as " t r Proposed Electr rk
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Cumolet n ofthe foltrilimiqtablemay,be,waliv el'bow the nsoccer IVirus.
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a r ss � � l r s o. r Ccil. Buse. t Fees
Na. of LightingOutlets No. ut Hut Tubs G n r t rs KVw
Above In- i . merce ,v i itillcy
No
t * trs raa ,. its
tNo. of Reiceplacle Outlets .of 01`1Burners FIPLE ALARMS or'Zones
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-O-fDetection and
No., Swit�ciies o. G s Burners yn y'h
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�f i ! ing D c i C CS
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No. or Ranaes No.
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f lr Coed. yaw. o,rAllerting Devices
Tons
Fleet a .. s - tined
. o. st Disposers "at Is wDevices
fts
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o Munic", al Other
Local
Connectioll
No. of Dryers tinAppliances
or Devices or
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Heaters S li1xs Ballasts No.orDevices or Ecuivalent
L w HN-dro a ss ge Batlitubs N o. ofi I otors Total lid No.o(Devicesor F iy l nt
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OTHER:
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INsU1' . " � 'fit � �s aiv tine �vne ,� 1a perm( for tie r r � e ' i ar i � r av �ss�� ��i ss
the i r s r iff s liabilityi as sr � ; l ira "completed `r ti i" o�w r g r its substantial ivatcat. is
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4 i ` s i t the permit i a�i�� .
� rs� certifies that sal �1301ND
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CHECK ONE: INSURANCE ;11111force, �a s is
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Estimated Value or Ei (tM t Work: art required by munl6pal 'ol"'Cl•
. i��s dons t requested Li r to with EC Rule10, n r upon i ti n.
Work t Start: '
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lPlc t* ti s tree mill ltrpl'"re�
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(If applicabte, entcr "w e.w-1u I` in d i license number�!"� s�Tel., o.:
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Address:
I t . tin t the " have the liability insurancev eras or
ONYLNER'S, INSURAtNCE NVAIVw 'y 11i y signature x , I hereby wa,iv dais,r air raa tit. I in the he n �