HomeMy WebLinkAboutWiring Permit - Permits #12004 - 63 BRIDLE PATH 11/18/2013 Date...y`........... ....
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<; p,,�LEG'CRICAL INSPECTOR � -�-"`
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Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRtCAL
WORK
All work to be performed in accordance witb the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT XNINK OR TYPE ALI.INFORAdATIOM Date: // / 13
City or Town of. Al To the.inspector of Wires:
By this application the undersigned gives notic of his or her intention to perform the electrical work described below.
Location(Street&Number)
Owner or Tenant /� s Telephone No.
Owner's Address
Is this permit In conjunction with a building permit? Yes ❑ " No ❑ Building Permit#
Purpose of Building ,/{ Utility Authorization No.
Existing Service �7__ ps Overhead ❑ Undgrd❑— No.of Meters
New Service Amps —Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: /ir/
Completion of the ollowin table may be waived by the Ins ector of Wires.
0.of Total
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators I V`l`
Above n- o.o mergency g ing
No.of Lighting Fixtures Swimming Pool nd. ❑ rnd. ❑ Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Gas Burners o.o Detection
aad
No.of Switches Initiating Devices
No.of Air Cond. Tons
te
of Alerting Devices
No.of Ranges Tons
No.of Waste Disposers eat mp ...um„,er...,,,,ons o - ontaine
Totals: ectlon/Alertl Devices
un cipa Other
No.of Dishwashers Space/Area Heating KW Local ❑ Connection
Heating Appliances ur ty ystems:
No,of Dryers g pp ' No.of Devices or Equivalent
o.of Water 0.0 No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or E uivalent
e ecommun ea ons sr ng:
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent
OTHER: '
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
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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 OND ❑ OTHER [I (Specify:) p;r Date�
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start://-/�-—/7 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
.l certify,under the pains and penalties of per,jury,that the information on this application is true and complete.Current
Xitsuraieee eertJfceat8 xrust be oriole In our office earl afj3duvlt.om&also he 'lied Out with each application. 1/1
FIRM NAME: ���w'r LIC.NO.:
Licensee: � 4 �., i Signature _ LIC.NO.: _
(If applic le,a ter 'exempt" the license number line.) Bus.Tel.No.:�1 �� 11`Y-
Address: S' - >' I Alt.Tel.No.•
OWNER'S INSURANCE W R: Tam aware that the Li�6densee oes not ha e the liahility insurance coverage normally
required by law. By my signature below,I hereby waive this requircincnt. I amhhe(,check one) Owner ❑owner's agent—
Owner/Agent PERMIT FEE: $ ,5
Signature Telephone No.