EP-69947 i Noj'lVT ' ARTMOUTH - BUILDING DEPARTMENT RECEIPT 699 7
gESPHONE: 508.910-''^ 0 SAX: 508-910-1838
Name: t i;"l v/11} l CY!_ - - �/,� /
��ffi.���, Property Owner: I f���" �' � -� Date.- '3
Job Loca i n: ,) J1, '(-tiff t 6 ..,�- P /(--"r Map: .. Lot: ' ,
Description General Ledger#'s Ref. # Amount
Br t"dig*Building Misc. 01000-44105
(Electrical 01000-44106 .•r ` , '':--, 0 S:2) -
'.
t mg & Gas 01000-44107 " ° °`f =
Trench Safety 01000-44129 MAY Z 2 2013
Other Department Revenue 01000-42420 . €T 5 `' THY '
_` y��/,n
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By !'a/ . '-*V VS''/
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS
ACommonwealth.o/Maodachuseitd Official Use Onl q (J
It_—#°—�/ cc�� cc77 Permit No. l-` 7
_4=1 .2epartment o/ ire Serviced
1,__�_f= Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rey. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S-? a -13
City or Town of: l,JoU'i'H1ov 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) / Svt►dui ce
Owner or Tenant Sic frr__ T avi S Telephone No. 50- '7 7/- ?S?S
Owner's Address.
Is this permit in conjunction with a building permit? Yes n No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service ? o Amps NO / 2YO Volts Overhead Undgrd❑f No.of Meters _I
New Service Amps / Volts Overhead n Undgrd❑ No.of Meters
Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W,pr it� for gLevc gr0e„ oa l/
cm 4 IAS t't( Lr q A? 4ni
_p/vo 1'vl V s h U
Completion of-the following table may be waived by the Inspector of Wires.
ofTotal
• No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans To,
TransformersKVA KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad. Battey Units
No.of Receptacle Outlets No.of Oil Burners FIRE 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 Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal 0 Other
I Connection
No.of Dryers Heating Appliances Imo' Securi tY 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 Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: S"3)_/ 3 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 cover is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of pedury,that the information on this pplication is true and complete.
FIRM NAME: J, Roll 4 t9/eclrece( LIC.NO.: A oo/GS
Licensee: aso✓l l Cor 4 Signature LIC.NO.: 1r SD l6$
(If applicable,enter "exempt"in the license number line.) la'
AA,A� Bus.Tel.No.: So S-?S?'SSg67
Address: l/GO merr'd`4n S$. PI la
I/ ' /"L/4 0?7a C!' 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)0 owner 0 owner' nt.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
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