HomeMy WebLinkAbout- Permits #11761 - 324 HILLSIDE ROAD 8/2/2013 j;
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PERMIT FOR WIRING
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wiring in the building of
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Permit No.
51'.S.,ac."
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 MR 12.00
(PLEASE PRINT IN INK OR TYTV A LINMRMATION) Date:
City or Town of. je To the Insp�cto�WWires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 111c,csi i')e- (6
Owner or Tenant TelephoneNo.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No F-1 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead F-1 Undgrd❑ No.of Meters
New Service Amps Volts Overhead F] Undgrd n No.of Meters
Number of Feeders and Ampacity -L 7, &# 7/- 0 u r-i,*,r
Location and Nature of Proposed Electrical Work:
Completion oj'the jblloivink.etable ma,be waived h the Ins ector of1fires.
No.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tr of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above E] �n ot Emergency Lighting
,7- —
No.of Luminaires Swimming Pool grnd. ❑ r_ d, 0 Batter y Units
A—
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS jNo.ofZones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
Heat Pump j.NM!Rq�rj.'jr.o.n,s JKW No.of Self-Contained
No.of Waste Disposers Totals: ........... .................... Detection/Alerting Devices
Municip al
No.of Dishwashers Space/Area Heating KW Local El Connection El Other
19—ce, rity S stems:*
No.of Dryers Heating Appliances KW No.of;evices 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 11'elecommunicaions Wiring:
No.of Devices or Equivalent N,
OTHER: A/AA A Ae4-4 d dw I'd
Attach additional detail ifdesired,or as required by the Inspector Wires.
Estimated Value of EIFFtr1 (When required by municipal policy.)
Work to Start* Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVER AIGE Unless less 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 cover ge is in force,and has exhibited proof of same to the permit issuing office. I CHECK ONE: INSURANCE a BOND El OTHER M (Specify:)
c/ I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. K)
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FIRM NAME ff)e- LIC.NO.: 1,
b .....w,tLicensee: ba is e
(ffpp1i,ab1,, enter llexe)npf"in'he license numbel,line.) Bi�ietel INO
Address: c",
.-,I LAA Alt:Tel'No::�WS 777.36,77
*Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety Lic.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) E] owner El owner's a e
Owner/Agent I ET FEE. $
Signature Telephone No.
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COMMONWEALTH OF MASSAGHUSETTS
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ELECTRICIANS
AS A REG JOURNEYMAN ELECTRICIAN .
ISSUES THE ABOVE LICENSE TO:
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JAMES P FINNE-GAN A
61 SOUTH MAIN ST
ASHBURNHAM MA 01430- 1635
37717 E 07/31/13 885348
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ASHBURNHAM MA 01430.1635
clf5 00 04-25.2010 Rev 07-15-2009