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HomeMy WebLinkAbout0020 PILGRIM LANE ao �;� � " v Q�� �� Office Use Only • a ' Elie ov 11uluutueattll of Angoadjugetto Permit No. lyei tlletinrtinflit of 11111111c jWet8 Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordanpe with the Massachusetts Electrical Code, 5 7 C R :00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date1 City or Town of VAA NI S To the Inspeclor of Wires: �� The udersigned applies for a permit to perform the electrical work described below. R Location (Street & Number) �,h , _ Owner or Tenant yk—cp—t C4- wiz' Owner's Address �_�I L,6,Vi NA ( � Is this permit In conjunction will) a: building permit: Yes ❑ No ® (Check Appropriate Box) I Purpose of Building RESIDENCE Utility Authorization No. LLJ� Existing Service Amps __J olls Overhead ❑ Undgrnd �E] o. of Meters New Service At / `Volts Overhead ❑ grndNo. of Meters Number of Feedet. d Ampacily Location and Nature of Proposed Electrical Work LOW.VOLTAGE BURGLAR ALARM SYSTEM No. of Lighting Outlets No, of I lot Tbbs No. of Ttonsforrners Total KVA No. of Llghling Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of,Emergency Lighting ! No. of Receptacle Outlets No. of Oil Burners Battery Units No, of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones �• Totni No. of Detection and �- No. of Ranges No. of Air Cond. Ions titillating Devices No. of Disposals No.ol Iloot Total Total Pumps. Tons KW No. of Sounding Devices No. of Sell Contained No. ofDishwashers Space/Area I feeling KW Detection/Sounding Devices No. of Dryers 1loolhrg Devices KW Local Municipal Othir No. of No. of Low Voltage + WIRELESS LOW a No. of Water Floaters KW Signs' Ballasts Wiring ' No. I lydro.Massage Tlrbs No. of Motors Total N VOLTAGE BURGLAR ALARM P co OTIIER: ll" INSURANCE COVERAGE: Pursuonl to the requlremonts ol'Mossolibusetis general Laws I have a current Liability insurance Policy Including Comslelod Operations Coverage or Its substantial equivalent. YES X] NO O 1 have submitted valid proof of same to the Office. YES N NO [ It you have checked YES; please Indicate_the type of coverage by checking the ap roprlete box. SEPT 1995 3INSURANCE L4 BOND O OTHER ❑ (Please Specify) (Ex iretlon Work Date) Estimated Value of Electrical Work S i�J �•0o to Start Inspection Dale Request Rough Final Signed under Ilia Prinattias of nerlurv: ---_- FIRM NAME • EXAMN INDUSTRIES, INC. LIC. No. 13950A Licensee LLOYD R• SMITH Slgnatur LIC. NO, 250 MAIN STREET PAWI'UCKET, RI 02860 Bus. Tel. No. 800-825-5400 Address All:Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Insurance coverage or Its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please chock one) Telephone No. PERMIT FEE $ 1 15`©o (Signature of Owner or Agent) x•8585