HomeMy WebLinkAboutWire Permit - Permits #12555 - 601 MAIN STREET 7/25/2004 WK
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Commonwealth of Massachusetts
Official Use Only Permit No.
Department of Fire Services
pj, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99]
Occupancy and Fee Checked
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts I]ectrical Code(MEQ,527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE AL L IATT,ORMA TION) Date: -7 /a :thy
City or Town of: Alor-+P1 'Wire Aodo - To the Inspector o ,y:
_Vc( V
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 Ail—ovei- ki"Aredae Ekmeri�&rj S'C.tl ce I Telephone No.
Owner's Address V
Is this permit in conjunction with a building permit? Yes F-1 No (Check Appropriate Box)
Purpose of Building HVAC s�js�4w r--eJr,4)4 Utility Authorization No.
Existing Service Amps Volts Overhead 1:1 UndgrdO No. of Meters
New Service Amps l Volts Overhead F Undgrd D No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
VAC Co#AV-01
Coinpletion q/theJbIlowing table may be waived by the Inspector of 1,171'res.
No. of Recessed Fixtures No.of Ceil.-Susp. (Paddle) Fans No. of Total
Transformers KVA
No. of Lighting Outlets No. of Hot Tubs Generators KVA
No. of Lighting Fixtures Swimming Pool Above of Emergency Lighting
grnd. rnd. Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. ofZones_
No. of Switches No. of Gas Burners No. of Detection and
Initiating Devices
No. of Ranges No.of Air Cond. Total No. of Alerting Devices
Tons
No. of Waste Disposers Heat Pump Number I Tons IKW iNo. of Self-Contained
Totals: ' Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local E] F-1 Municipal Other
,I Connection
No. of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No. of Water KW No. of No. of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
Na. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:No.of Devices or Equivalent
OTHER:
,Ptach additional detail ildesired,or as required by the Inspector o/Wires.
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 3 BOND [-] OTHER El (Specify:)
(Expiration f)ate)
Estimated Value of Electrical Work: 00. C 0 (When required by municipal policy.)
Work to Start: -7 Inspections tobe requested in accordance with MEC Rule 10, and upon completion.
I certify
, under the pains andpenalties of perjury, that the information on this application is true and complete.
FIRM NAME: hF_T Sws•4vms', LLC LIC. NO.: ;JvJvaA
Licensee: Signature �LIC. NO.:ao40.
A
oplicable, enter "exempt"in thaidense num be),line) /"Bus. Tel. No.: !L7 f�—L,4 0-9,4SO
Address: I �� Mal 01977 kp Alt. Tel. No.:t003-3 6,s -b 0,30
OWNER'S INSURANCE WAIVER: I arn aware that did 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) R owner 11 owner's agent.
Owner/Agent
Signature Telephone No. FERIVIIT FEE. $ rl 0