EP-76946 N1 `i; '0j• r I` 7) ' "'I MOUTH - BUILDING DEPARTMENT RECEIPT 7g 69-1 6
i . : 508.910-1820`kFAX: 508-910-1838
Name: -.1/ a I 1 1 Aria? IL Property Owner j V it d S it(
W(A----
/^, Date:
Job Location: /� 4 / rc.p 6 E /(7GC_ Map: tp Lot:
Description General Ledger#'sp1A0� # Amount
Building &Building Misc. 01000-44105 , P Q, Y \\\
Electrical 01000-44106 o f'C ;�e� f- i:)"
Plumbing & Gas 01000-44107 44* a'
Trench Safety 01000-44129 T NC e _.
Other Department Revenue 01000-42420 A
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By t 7�
THIS IS NOT A PERMITAJCENSE FOR BUILDING, ELECTRIC , PLUMBING OR GAS
/
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(�„ Commonwealth o f rrlamac etfe Official Use Only
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t \ 'C= rMi a/ cy� c7• Permit No.
nl g apartment o� ae ewicaa
�_ " • Occupancy and Fee Check'
�� °'•, - sJ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07j ?
(leave blank
. APPLICATION FOR PERMIT T . ERFORM ELECTRICAL
All work to be performed in accordance with th Massachusetts Electrical Code(MECk 527 CMR}2E00,,/
(PLEASE PRINT IN INK OR TYPE ALL INFORMATI IV) Date: 11 T_ I
City or Town of: De 2'(-Yt,o.tt\n \ To the Inspect r of Tres:
By this application the undersigned gives notice of his or her\ntention to perform the electri I workdescribed below.
Location(Street&Number) [9'7. ( REED �D,_
Owner or Tenant V en/dCQf Telephone No. SaS-YZZ°Ll b
Owner's Address
Is this permit in conjunction with a building`I permit? Yes'- No n CbeckAppropriate Box)
Purpose of Building a Ill
'v' v1 Utility uthor ttonNg.
Existing Service /00 Amps 120 /240 Volts Overhead Und d❑ ,"No.of Meters 1
New Service Amps / Volts Overhead n " d ❑. No.of Meters
Number of Feeders and Ampacity Zi'
Location and Nature of Proposed Electrical Work: ;IAA/ ROO OK ;EA* g F" Y-/
`1 Peee I ,itt(5 3 Flcoo (''ht) l
Completion of the following table may be waived by the Inspector of Wires.
Total
No.(*Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans • T '
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above ❑ In- ❑ No.of Emergency Lighting
No.of Luminaires Swimming Pool
grad. grnd. Battery Units
.7 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS ro.of Zones
No.of Switches No.of Gas Burners No.of Detection and
''i2 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❑ Munionnectcipion al ElOther
C
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
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin :
No.of Devices or Equivalent
OTHER:
OD Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: /ZO0- , (When required by municipal policy.)
Work to Start: `ir/3""20/5.- 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 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and enalties a/perjuryy thgt the information on this application is true and complete.
FIRM NAME:/' 5/077 Ci�re�/Scl/e f ec'I-tt'au.0 LIC.NO.:38/V Q t
Licensee:7t,j7 rLL V rte.-a Signature LIC.NO.: C
(If applicable,enter "exempt"in the licgnse nipr�,er line.) Bus.Tel.No.:5 v -3 �0'��
Address: S"1 Z (CM") 5 t, 4� 'J�^4`- Alt.Tel.No.:
*Per M.G.L.c. 147,s.57- security work req es Department of Public Safety"S"License: Lie.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 agent.
Owner/Agent /�
Signature Telephone No. PERMIT FEE: $
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