EP-71172 L ' I o f PARTMOUTH - BUMPING DEPARTMENT RECEIPT 7117
e ‘ 4 v ,,,,digii6 ' 0 PHONE: 508-910-1820'LFAX: 508•910.1838 1
/ (( C.� lc fe` ,
Name:I-- 1 S,-//2tiii' C" „jiltIProperty Owner: /(- (1- '�- /Cc Dater ! w
,410
i/ f /�/ 4//Ahs%:
/ /IJob Location: l 7 T1/ L' (�' Lot: 1J
Description General Ledger#'s Ref. # Amount
Building & Building Misc. 01000-44105
Electrical 01000-44106 Al, f0;//er— jam , (2%
Plumbing & Gas 01000-44107 /91 DA;&
Trench Safety 01000-44129 4 MC G=
Other Department Revenue 01000-42420 SEP 1 qA 90t3 / /L
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department '...bp RecClved / .4-�-'f / -- -
THIS IS NOT A PERMITILICENSE FOR BUILDING, E , PL' BING OR GAS
pp�� qqryr)/� fI &67/s/
Commonwealth.o///Jaaaactaaoela Official Use Only
rE-ry,=ri ty cc77 (� Permit No. 17//f 7`
__re= s 2aparfinent o�.Pire&raicrr i
-:---- : BOARD OF FIRE PREVENTION REGULATIONS [Rev. 07 and Fee(leave blanCnk)ked � G' (/
k)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD
All work to be performed in accordance with the Massachusetts Electrical Code C), 7 CMR 12.00
(PLEASE PRINT IN INK OR TgE A INFORMATTO.N) Date: 9 /7//3
City or Town of: /�jr/µicv44 To the In ect r of Wires:
By this application the undersigned gives notice of his o�� /r�her intention to perform the electrical work described below.
Location(Street&Nu/m/6er) CJ Dar vinty T t1 ?5#-in Wit'
Owner or Tenant Agii•hyl,'p Dq Piorq Telephone No.SD$'-ceg&•/Sr/l/
Owner's Address ,�,/
Is this permit in conjunction with a building permit? Yes E" No El (Check Appropriate Box)
Purpose of Building PeSt(XiesiC e Utility Authorization No.
Existing Service edt, Amps /00 1 Z4b Volts Overhead 1 Undgrd❑ No.of Meters I
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:,fi `di 3 q Pvs0/kc-
leer!/* enr /Zero 4. 7s Kw
Completion of the following/able may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf Tat
Transformers ICVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting
=.� grad. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FTRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Connection
No.of Dryers Heating Appliances ICW 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
No.Hydromassage Bathtubs Na.of Mofors Total HP Telecommunications Wiring:
-/ No.of Devices or Equivalent
OTHER: Pi/ 6cA— iSe/�i'
_r Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value f Elec cal Work: 4S SDl7 (When required by municipal policy.)
Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:)
I certify,ender t!��rD ains and penalties of perjury,that Solar—
infernmtion on t rrs application is true and complete.
NAME:FIRM 7f �tp yNOS156 s St rl/r of `L C 77 LIC.NO.:
Licensee: yA :: es' ,(e/ ArF- 01' Signature ,,,,cp4ea,, ,t? LIC.NO.• 4 6,0cf,R-
ataPplicabl e}x{er exempt"ihh the licensenumber lia�/J Bus.Tel.No.. etiti
Address: `7 r Wa514 i/s1d OT flit( AA , Aft' /j/7(,0 Alt.Tel.No.:
'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: 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)❑owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$
,\(,)
�
A
A