19-002 (3) t
t Commonwealth of///assn°�imeda Official Use Only
Permit No.
lleparGuni o`.1iro Jrwicu
Occupancy and Fee Checked
lug BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mamehosens Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE LLINFO 9ATION{ Date: 12 - 21 — IF
City or Towo of: U° v To the Inspector of Wires:
By this application the undersigned gives notice of his or het intention to erfothe electrical work described below.
Location(Street&Number) 2 f Z, Jrm
Owner or Tenant p Telephone No. t I$ a kem
Owner's Address 11Ah.�s•.r ..<-�' t,-l.L�. rti 0),7
Is this permit in conjunction with abuilding
1pgrmit? Yes No E] (Check Appropriate Box) 4w
Purpose of Building II-C%xd.efl. 44 Utility Authorization No. ,�c
Existing Service it" Amps 1 Z° / 2f(Volts Overhead V] Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location aad Nature of Proposed Electrical Work:
Com letion o the filinuhric able be oicdb,,the loupeanafiriot.
No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans NO.01 Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- o.o mergency Lighting
No.of Luminaires Swimming Pool rnd. E3rnd. ❑ Batts Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS Na.of Zones
No.of Switches No.of Gas Burners o.of Detection an
Initiating Devices
No.of Ranges No.of Air Coad. Total
Tons No.of Alerting Devices
No.of Waste Disposers eat ump um er ons. .... o.o e - ontame
P Totals: I Detection/Alertin Devices
No.of Dishwashers S ace/Area Heating KW Local❑ umctpM ❑ Other
P g Connection
No.ofD Dryers Heating Appliances KW uri ystems:
rY No.of Devices or Equivalent
No.o atero.o o.o Data Wiring:
Heaters KW Signs Ballasts No.of Devices or E uba�llent
No.Hydromassage Bathtubs No.of Motors Total HP el communicathons 11111111No.of Devices or E utvalent
OTHER:
Attach additional detail ifdesired,or as required by the Inspector of B'ime
Estimated Value of Electrical Work: (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,under the pains and penalties of perjuty,that the information on this application is true and completes rr�.na2-
FIRM NAME: LIC.NO.:y°
Licensee: I' Signature LIC.NO.: SOS 16'
(IfapPlicable,coteVexempt'i the 1' a pgtuber linp/ /'1 / /^ Bus.Tel.No: .f3-2/P-20 3
Address: 1 7 L.4 0 V t e1 [ 9 tFt71 a 5PT lO( ✓'La . U I I b `/ sti Tel.No.:
'Per M.G.L.c. 147,s.57-61,security work requires Deparbn nt of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: 1 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. w
Owner/Agent PERMIT FEE: $
Signature Telephone No.
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212 DAMON RD EP-2018-0459
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Map: 19
I.ot:002 ELECTRICAL PERMIT
Permit: Electrical
Category: REWIRE ENTIRE HOUSE
Permit# Electrical
PERMISSION IS HEREBY GRANTED TO:
Project p JS-2018-001173
Est.Cost: Contractor: L' en
F«: $125.00 JAMES DESMARAIS Joume an Electrician 37013
Owner: OGUNFEIBO OLATOMIDE
AppUcant JAMES DESMARAI
AT. 212 DAMON RD
AaaUcant Address Phone surance
72 LACLEDE AVE (413)250-4774()C- Liability, CP 140596385
CHICOPEE MA01020 ISSUED ON:12115/20170:00:00
TO PERFORM THE FOLLOWING WORK
REWIRE ENTIRE HOUSE — Cq j—
Cell In Date: Date Requested Ins ectlon at i n Reim eM?:
Trench/UG: NV
Special Instructions
x
Rou h
x
Special Instructions _
Final:
SHE Called In: 4- NO - %0 -da-Ilt - Q,1 i. , � L�dl.� � DRQ/ cn ' itart �
Sieoature•
Fee Txw:: Amount: DatePaid
Electrical $125.00 12/152017 0:00:00 1026
212 Main Street,Phone(413)587.1244,Fax(413)587-1272-Inspector of Wires -Roger Malo
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