HomeMy WebLinkAboutMiscellaneous - Rocky's Hardware Acem
W
0
z
0
Z
LL
0
Z
0
Official Use Only
C�osnmonwealth o� /f%a�ac�etf� �% i
1 cc�� c7
Permit No.
�:_ . _ _ _ vUepartment o�.}ire �ervices .
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION. REGULATIONS [Rev. 1107] Qeaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All -.vork to be performed in accordance with the Massachusetts EIectrical Code (MEC), 527 CMR 12.00 Q
(PLlf1SE PRINTW INK OR TYPE ALL INFORMAnom Date: 11 1 It 1 -s -_.
City or'Town of: �I - ��1� Q V E To the Inspector of Wires: _
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) So 7�-1 -F-, S i Q "' F— P�
Z
Owner or Tenant rY' S Telephone No. 794 SO
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) r�_
Purpose of Building (Z. TPS Utility Authorization No.
/ Volts Overhead ❑ Undgrd ❑ No. of Meters
Existing Scrvicc Amps
New Service --Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity —
Location and Nature of Proposed Electrical Work: W„�, n�t> d i
t Completion ofthe f, it vin table may be waived b the Inspector of YYires.
No. of Total
No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers KVA
No. of Luminaire Outlets
® No. of Hot Tubs Generators ICVA
Above In- 0.0 mergency ig mg
No. of Luminaires Swimming Poal rnd ❑ rnd. El
Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones
No. of Detection and
No. of Switches No. of Gas Burners Initiatin Devices
Total
No. of Ranges No. of Air Cond. Tons No. of Alerting Devices
Heat Pump Number_ Tons ICW _ No. of
No. of Waste D Self -Contained
Disposers Totals: -� Detection/Alerting Devices
Municipali
No. of Dishwashers Space/Area Heating ICW Local EJ❑Other
g Connection
HeatingA liances KW Security Systems:x
No. of Dryers pp No. of Devices or E uivalent -�
No. of Water ,; No. of No. of Data Wiring:
TCW Ballasts No. of Devices or E quivalent
Heaters Signs
^C� Telecommunications Wiring:
No. Hydromassage Bathtubs No. of Motors [ Total •IIP No. of Devices or Equivalent
IOTi-IER-A
• ' tt�
ach additional detail if desired, or as required by the Inspector of lYires
Estimated Value of Electrical Work- Lj �_epe6 (When required by municipal policy.)
Work to Start: t Inspections to be requested in accordance with MEC Rule 1.0, and upon completion.
INSURANCE COVE RAGE: 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 cov rage is in force, and has exhibited proof of sa a to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER 0'(Specify:) F CSA T>i r
I certify, under the pains and penalties of perjury, that the informatio n t application is trete and complete
FIRM NAME: Cote 1 t=' LTC. NO.: J Z .SCJ A
Ls
Licensee: Signature- LIC. NO. $ 33 G E
.�77 _S9TV
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: r' �s'�
Address: /6 Lorseitty. c -i ?A, W LkmtJ AA ti. O lq u9 Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lia 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) ❑ owner ❑ owner's a ent.
Owner/Agent rER1 TIT FEE: $
Signature Telephone No.
:# auolld mos lad TaEluoD
.laglo '9
solnadsuI2uigmn[d'S iol3adsul lenulaalg-1, 3laalJ un os,/[4tj -£ luaurl.irda(I DuiPIIng'Z glleag jo p.1rog -1
:(auo alnlla) (ilxotI)nd 2utnssi
# asua:)T-w!m.lad :u,uos JO ilio
7v/3iffb unto) Jo &;a dCq paialduro.7 aq of `vale slip ur anim iou oQ 'd7uo asn Ima�.�p
( c to S (- i-1-- L 6 :# auolld
t oll if :21EQ :atniEualS
.7oal ioa puv ani; si adogv pap/do.rd uopDwioJuq arp avq; dintxad; jo sainvuad puv-suly 1; J un i�Jaa rCga rayl op I
uoilEnl�uan aBEIanon aausm zo; Q atjl;o suo11e�11sanul
;o oolgj0 aqi of papmugj oq Amu ivauualgs sigi;o Moo 'e Imp pasinpu ag •IOIElotn iSQIE$E S72P E 00'OSZS 01 do;o
ami E PIIe N90do XUOM dO.LS le JO uuo; aqi u1 sajllEuad pA!:) se Ilam se `luauruosudun .read-auo to/pue 00'00S` I S of do au1g
1 E;o satlluuad Impuuo jo uoTllsodun ails of pEal uun ZSI •o -10W jo bSZ uoilnaS .spun pannbai se a5Elano3 amnas 01 aml.M
-(alvp uopumd%a puu xagtanu Sz)god ails 2IIlmogs) a2ud umu ml3ap t.311od uopesuadmoa �S-mi rom aip jo Sdoa E ilasl;-r
05; :m-Lpp`d ;niS qof
:21EQ uopendxg :# ,at7 *Sul -jigs to # ,Cotlod
. . d � :aureH ,tuedmo0 aauemsul y,
u0ljvurl0fIq S
any gof pup d-ailod ay; sl molog Saadoldiva diu tof aoumnsui uopvsuadzuoo ,slayjom ffuMlAo.id si ling Jadoldula uv uiv j
y
•ngwnu k3tlod •dwoo ,sn3liom rayl aptnotd ism day; 'saadoldwa anuq slolo"um-gns 2y131 -=Xoldwa
aney satlqua•asogl lou to taglaym alels pue siolacquoa qns ayl;o auieu ayl �utmogs hays lauogtppu ue pagaeue ism
xoq stye Kaaga leya siolaEnuo0l
-vans 8utnea1put itnepWe mau a ittugns lsnw siolmquoa aptsino any ump pue Atom (le dutop an days $uuuatput ltnept3u stgl ltwgns oqm staumoawoy
•uotlanigjut •Catlod uogesuAwco ,simliom mn $utmoys molaq uo!i=s aqp wo 113 osle lsnw 1# xoq gwga leyl m,3tlddu dud,
Ia�O �•EI
satEdai;00-d F•ZI
saotl.ppe io sm&i 3uigamid ❑' I I
suoglppe to snedai IEnWaalg. p•01
uotitppe ft
pltnEf [:1 -5
uop!louua(I ❑ -g
2uilapoma21 ❑ •L
uopmu4suoo MON ❑ '9
:(pa:nnba.i) laafoad;o acUl
[•panllbai anuemsul -dmon
.m3liom ON) -=Xoldma
ou anEq am puE `(},)I§ `ZSI 'n
1 [•Paitnbai oouemsui
-If)jq sad uoiidwaxa;o lgSp
•dam ,simltom ON] ;las,ttu
iialli paslnIM aAEq SI231UO
3[tom Ile RmOp .IaumOamOq E an I R .£
sit puE uo9wodioo E an aM El •S
[-pamtbai
# aouEmsui •dmoa
anuumsut •duioo �wo3pom ON]
9sia)liom anEq pue saa,Coldma
,Citnedva �CuE u1 aur 10; �unliom
anEq voloE.uuoo-qns asagL
saa,toldura ou oAlaq puE dells
-hags pagnEur otp up. paisil
-mui.- ;o *eiaiadoici mos L' 1uY 1 Z
ssolnetluon-qns agi parol aneq
I PUB ioiae-Auoo le.raua2 a um I � •ti
*•(gruq-)md io/pue Ilnj) soadoldmo
rilim ra�foldma a un I I
:xoq alul.ido iddii aip XnagO I mSolduua uc x a1v
Is /- b :# auogd b o
r-4 Cl -1-3 K'Q 1 Iq VIS s, t : ssasPPV
" `' f :(IUnPtdtPuI/UO! ztuegtpissautsng) au mN
lqi arl 17auj asuald uopetuxo;nI JU733!i
vaquinld/sueYai.��aaszo�ae.puo�/sxapling :IxnEpWV aautunsul uopEsuaduio3 slaN.IoM
mp/n02•ssvfit -ntMM .<
IIIZO Y'N `iroisog
laa'us Iro7eznilsv�q 009
su0ilv.3i;saillijf0 aa�•'O
s;uappiV IzgjIsnpul fo mrarumdaa
spasnyooms lyfo g771vnurou1rrroJ 01111 �.
iiN
SOARDW.
ELECTRIC! -ANS I
ISSUES TFIE FOtLOW1 NG LI''CENSEi
AS .A REG'.JOURNEYMAN;'E LE CTR ICIAN �
z
JAMES J CARBONS fa
16 LIBERTY ST .;•
111DDLETON MA 01949-1 02
28336,E. 07/31%16 39797
-- '�'
'�',`�irr�i'C
C iAMONWEALTH OF MAcS. SA�'ol}' USEETTS
...5. ";5' �l n.. 4 ,�'3 ..,✓ .."�,h Tf "s -.'a a t{i�i*.+'� a ..'I n�� .".s�-r Y"r3 $ c S�E'(a. '.
E.LEG7RICIANS ,
fSSUES. THE..FOLLOWING 1~-}CEE�SE AS:A Y
REGISTERED MASTER, ,ELECTRI_C1AN<:
F:
AMES J CARBONE
6 LIBERTX STREET
ffDDLETON MA 01949-1802 1
18350 A 07/31/16:; 39798--
_0 -
9798.._1-
Massachusetts - Department of Public Safety
-r• Board of Building Reguiations and Standards
('sallst rilclio" Su er%i:tit37- +moi
License: CS -093882 `
1
JAMES J CARBONS rir.
16 LIBERTY ST
MlDDLETgV MA 01949
r
l ,1
-f� .")/�� q4. �• �: EiCI7lrattLlll
Commissioner 1212412013
t
a