S. Smith Electrical Permit Application圃
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BOARD OF FIRE PREVENTION REGULATIONS
O鎚cialUseOnly
PermitNo.
OccupancyandFeeChecked
[Rev・1/07](1。a,。bl。血)
APPLICATION FOR PERM漢T TO PERFORM ELECTRICAL WORK
All work to be perfomed in accordance w抽the Massachusetts Electrical Code (MEC), 527 CMR 12.00
岬L且4SE PRWTH刷VK OR TYPE ALL 」NFORM4 HO砂 Date:
City or Town of:Tb the h呼,eCtOr Qf脇res.・
By this application血e undersigned gives notice ofhis or her intention to perfom血e electrical work described below,
Location (Street & Number)
Owner or Tenant
Ow血erls Address
Telephone No.
Is thispemitin conjunctionwith abuildingpemit? Yes □ No □ (CheckAppropriateB。X)
Purpose of Building
Existing Service _ Amps
New Service Amps
Number of Feeders and Ampacity
l Volts
I Volts
Utility Authorization No.
Overhead□ undgrd□ No.ofMeters
0verhead□ undgrd□ No.ofMeters
Location and Nature ofProposed Electrica葵Work:
Completionofthe/bllow城中ab/emaybewalvedby/heJ"SpeCtOrOfmre$.
No.ofRecessedLuminaires No.ofCeil.-Susp.a,addle)Fans No.of Total Transformers KVA
No.ofLuminaireOutlets No.ofHotTubs Generators KVA
No.ofLuminaires SwimmingPoo12藍e□監d.□ 川o・0重止血ergency」重g血書l血g BatteryUnits
No.ofReceptacleOutlets No.ofO軸Burners F量珊AしAMSINo・Ofzo血es
No.ofSwitches No.ofGasBumers No.ofDetectionand InitiatingDevices
No.ofRanges No・OfAirCond・ 革謹 No・OfAle巾ingDevices
No・OfWasteDisposers 批無難i叩理甲骨蝉・・・半華…・・… No.ofSelf-Contained Detection/Alertin里Devices
No.ofDishwashers SpaceIAreaHeatingKW Loc運l□学監藷蕊□伽er
No.ofD重yerS HeatingApp血nces∴∴∴∴KW Sec灘恕揺霊.E。uiv。,。n,
No.of惟蕊。,S KW No.of No.of Si里nS Bal看asts Da富霊蕊ふ.。.E。uiv。,。n,
No.HydromassageBathtubs No.ofMotors Tota!HP T醤縄雅語盤荒塩皿t
OTHER:
Estimated Value of Electrical Work:
Wo正to Sta巾:
Attach c!C肋tional `かai/ #‘desired or as required句′ the力o平)eCtOr Qr mreS.
(When required by municipal policy.)
Inspections to be requested in accordance with MEC Rule l O, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, nO Permit for血e performance of electrical woIk may issue unless
the licensee provides proof of liabi獲ity insurance including ``completed operation" coverage or its substantial equivalent. The
undersign臆ed ce正fies血at such coverage is in force, and has exhibited proof of sane to the pemit issumg o飾ce.
CHECKONE‥ ENSURANCE □ BOND □ oTHER □ (Specify:)
J cer幼,, mくわγ肋epa融a!J!dpena舶鮒〆re功v切f脇t !he可的棚ation on !繭呼は肋cation応加e and co〃phぬ
FIRM NAME :
Licensee:SigⅡatu re
(ゲq岬licableタenter “exempt” Jn /he /icense number line )
Address :
*Per M.G.L. c. 147, S・ 57-61, SeCurity work requires Department ofPublic Safdy “S” License:
L量C・ N〇・:臆し写す碓
L量C・ N〇・:フI 13qA
Rus. Tci. No.:
Alt. Tel. No.:
Lic. No.
OWNER’S INSURANCE WAIVER: I am aware that the Licensee does ”Ot hal,e the liability insurance coverage noma11y
required by law. By my signature below, I hereby waive血is requirement, I am the (check one
Own e r/Agen t
Sigmture Telephone No.
□ owner □ owner’sa
PERMずT F服$
Solar
62 West Parsons Lane, Florence, MA 01062
62 West Parsons Lane
Florence
Scott Smith
11/22/22
(413) 446-5529
(413) 446-5529413-584-8844116 Pleasant Street, Suite 321, Easthampton, MA 01027
Valley Solar LLC
Winter 2023
Installation of 22 panel roof mounted solar array. System size 8.03kW DC.
$12,079
200 120 240 1
1/26.62A
664A1