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HomeMy WebLinkAbout0015 GENERAL PATTON DRIVE i II ,Y 1 �. +-� �- �= Page 2 of 3 {� �• S � a � i Y � yY •I F y .• _ x _ 4/16/2014 1 s. 8 � e EP T'y � CIO'- *"Woo* _ f u Page 2 of 3 t_ "Mi I 1 R 1 p t ! r h ; t...-..a .-. ♦.. 9 Is o { u sti 4 u 4/16/2014 u �) owner--ta APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE Inspector o/.� £ Wiring Permit #, COM/Elle�ctri� ®� ' Town of /� Massachusetts Building Permit # Dates Customer. L6)RAAI A.�� `- )r4 G�`er/l on(Street #) Z � G��►f�'�,��— 1'�l�G'r�. J Lot # in the village o ^�g utility pole nu ber or undergro il—number, 'S_�1 7 /7 Customer's billing addrecc 0 Temporary New installa ion Change of service Starting date Job description zl� .7,e* Service entrance voltage Amperage Phase Wire size(cu.or al.) > Conductor per phase Number of meters_/--Water heater 1z peak: Yes No— �D_ Estimated load:Electric., e.g—kw,dightc, kw,Range, dr-yer-�Motors;HT.-*-PhaN'e — Ready for first inspection L77-iiL s Ready for final inspection r� Electrical Contractor _ z ? Lic. # Z.3"Pe c Telephone# Address 7 17- S.C.+,�- Al O .2-!6 a Additional Remarks: Do•Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES . INSPECTIONS DATE FEE CHARGE Temporary Service Roughing in LVAUJI NA 1�_&S U LH Service and Meter Off Peak Meter Final Approval Disapproved' 'For the following reasons CERTIFICATE OF INSPECTION Date :q-r_'a To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been completed and has this day been inspected and approval granted for connection to your service. nspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46 INSPECTOR'S NOTICE The Commonwealth ofAfossochusetts :iicc lSe On Oly P,rriE No. -`a _h V_-= Department of Public Safety o l+. _ Occupancy S Fee Decked i' BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetu FJectrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR WE ALL JINFOP � ) Date City or Town of ��(/V� /6% To the Inspector of Wires: The undersigned applies for a permit to�peerforce the �electrical work described below(. Location (Street Number) C.' F.-IV6.y- O- ler or Tenant (� �C+ `i/� � /L � o--1er`s Address A� 0 6// 96-4'+ilA Ar/ [rt�9�"ffj�/?%4n,e4(,p 17AU_S Is this permit in conjunction with a building permit: Yes ❑ No El_ (Check Appropriate Box) Purpose of Building Q Utility Authorization N0. CS-12 7 Existing Service Asps / Volts Overhead �❑ Undgrd ❑ No. of hfeters_ New Servi 12 ce p© Amps / o volts Overhead LJ U No. of Y,eters *Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work IyCCQ/ d )r0J-L fa f No. of Lighting Outlets No. of Hot Tubs /�/ No. of Transformers TKVA J No. of Lighting Fixtures Swimming Pool Above In grnd. ❑ ,,rnd. ❑ Generators h'VA No. of Receptacle Outlets No. of Oil Burners No.Bat of Emergency Lighting Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Dis osals No, of }lent Total Total No, of Sounding Devices P Pumps Tons }7J No. of Self Contained P;o. of Dishwashers Space/Area Heating KW Detection/Sounding Devices So. of Dryers Heatin Devices W Local ❑ `tunicipal ❑Other �- g Connection No, of No. of (Low Voltage No. of Water Heaters i`�J ISicns Ballasts Wirine No. Hydro Massage Tubs No. of Motors Total H? OTHER: I:;Su�',_';CE COVE%'GE: Pursuant to the require-ents .of Massachusetts General Laws I have a current Liability Insurance Policy including Cc•:pleted Operations Coverage or its substantial eeui•:alent. `.ES�`;0 (] I have submitted valid proof o_ same •to this office. •fEs t;o If ycu have chec,ed YES, please indicate the type of coverage by checking the appropriate box. !,;SL,kk;CE B'BO!,D ❑ OTHER 'J (Please Spec 1- 4 94 tExpiration Date) Estimated Value of Electrical Work S Work to Star t/ Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME LIC. NO. Licensee S i g n a t u rpf_� LIC. P;O. ,�Cf �4, Bus. T No. Address 2 —� Alt. Tel. No. �Gy'� ¢ OIWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit' application waives this requirement. Omer Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent