HomeMy WebLinkAboutWiring Permit - Building Permit - 45 GLENWOOD STREET 12/2/2013 i
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PERMIT FOR WIRING
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BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
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(PLEASE PRINT IN INK OR Typ L INFO%A TION) Date:
of: y"t cl of
p�' To the Inspector of Wi'res:
City or Town — XeLx LN
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant k e, T1\l-o-e)cj fit',c Telephone No. "i's--
Owner's Address �_S a
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 F1 No.of Meters
New Service Amps Volts Overhead❑ UndgrdE1 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 01le ks,s 3e1lZC1/'1 Z:,.: 'S
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Completion gl'the,1611mving table inay be ivaived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above Ei In- N-0.01 Emergency Lighting
No.of Luminaires Swimming Pool grnd. grnd. El Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal El Other
Connection
No.of Dryers Heating Appliances KW Securi Systes:*
No.ty of Devicmes or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 5 (When required by municipal policy.)
Work to Start: 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE 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 R BOND R OTHER R (Specify:)
I certify,under the yarns andpenalties ofpeijivy,that the inforination on this application is true and complete.
FIRM NAM, INJiYl(")� LIC.NO.: s-
Licensee: ,T 16 Ilk,,
, , �- • T'j-r l" 2 / LIC.NO.:
1�,,�,Y Signature ( �A-
(ffopplicable,enter "exeinpt"in the license number line.) Tel.No.:
a r '),'? kee ,144A- UZI Alt.Tel.No.:Y/ -2 6-
Address: f�R21�� Z,�,fl S e, P"// �421 1),11 2./
*Per M.G.L.c. 147,s. 57-61,security work requires Department of Pub Safety"S"License: Lie.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 F owner E]owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
EtpAS1�b= U
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE AS A
REGISTERED MASTER ELECTRICIAN
SPEEDWIRE INC
CHRISTOPHER J TREMBLAY
57 HARRIS ST
NORTH ADAMS MA 01247-2338 - °
18365 A 07/31/16 36270
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SS-001895
OWSTOPHER J TREMBLAY
393 Jericho Tpk S6
Mineola NY 11501
05/24/2015