22B-067 (5) •
•
215 BRING ST COMMONWEALTH OF MASSACHUS. BP-2022-0537
Map::Block:Lot: ETTS
22B-067-001 CITY OF NORTHAMPTON
Permit; Alts Renovations
• Repair
PERSONS CQNTRACTING WITH UNREGISTERED CONTRACTORS
• DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0537 PERMISSION IS HEREBY GRANTED TO:
• . Project# RENO BARN/ADDITION Contractor: License:
• Est.Cost: 237000 DANIEL PEDERSEN 106194
Const.Gass: Exp.Date:06)07/2023
Use Group: Owner: GROW FOOD NORTHAMPTON INC .
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: DANIEL PEDERSEN
Applicant Address Phone: Insurance:
64 VILLAGE HILL RD (413)531-9026
WILLIAMSBURG, MA 01096
ISSUED ON:05/20/2022
TO PERFORM THE FOLLOWING WORK:
RENO BARN AND ADD WASHROOM ADDITION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing inspector of Wiring D.P.W. Building Inspector •
7r20
Underground: '6-Service: Meter: Footings:1. ... 1;A-a r as o r 4-7-Z Dry
Rough:8 /9— 5 Rough: House#1 Foundation: 01C (0-10_Zz K�'�•
Final: ✓ " (,J�'fnal:7 ? c'13 Final: Rough Frame: •j 1
Gas: Fire Departmeht Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:O. 2, L I. 2
Smoke: Final:
et.•IL I1-11-Z3K•Q
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $1,659.00 6•- z,c,22_p51 1
ook-
koit
•
•
•
•
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 •
Office of the Building Commissioner
F14uk.. / .
.Z-(b 5Y(e--1 NG S //��
Commonwsa``,,h o/Ill yy�aaaachwstie Official Use Only
B ill
2epa iirwa[el_fire&micse Permit No. lam/'Zp22 Oo2
_ ,` Occupancy and Fee Checked#I 4 1
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] ( ve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
c_.) IN All work to be performed in accordance with the Massachusetts Electrical Code ME ,527 CMR 12.00
(PL4SE PRINT' INK OR TYPE ALL INFQRMATIOII) Date: \1 1C�21—
City or Town of: I)0 I -& i-o�-\ 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) ?—k c S (.v vl 9 r t..41.4
Owner or Tenant (N okk L Ff ,Ti, t Telephone No. H 1 7 7l- `i 12 7
Owner's Address '_O' Si)( 'on 1- c,,F zti C-e-
Is this permit in conjunction with a bag permit? Yes ❑ No Z (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volta Overhead❑ Undgrd 0 No.of Meters
New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity 1
Location and Nature of Proposed Electrical Work; (u,v 1 a�,,`t �v e Xk-e l ,o; ,"^z-\ 1
1CatiAiw0Se5i W‘ce, r ,,Loo e,
Completion of the followin• table may be waived by the for of Wires.
'Nol
No.of Recessed Luminaires No.of Ceil.-Snap.(Paddle)Fags of Inspector
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
g grad. and, Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No. betec ic
Initiating
e
Devices
No.of Ranges No.of Air Cond. Totalo No.of Alerting Devices
Na of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Monuninec tiocipal n ❑ Other
No.of Dryers Heating Appliances KW SecuriNo.of Syst
ems:*
or Equivalent f
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNofDevicesor Wiring.
Na of Devices Equivalent
OTHER:
Attach additional detail if desired or as required by the Inspector of Wirer
Estimated Value of 1 'cal Work: (When required by municipal policy.)
Work to Start: 11 21 2 2- Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C VERAGE: 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 covprage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OND 0 OTHER 0 (Specify:)
I certify,under&e pater and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: 1 t Ai a rN Cr a µ, h04 E tt, c,ia„, 1-1-(- LIC.NO.:
Licensee: ,c,,C lea h C is✓ "K Signatare `"::-.-- --s%� LIC.NO.: 1'4(,0 6 g
of applicable,enter"exempt"II the license number ire.) Bus.TeL No.:
Address: 1- r.. r `\ A A. r„ ,% ,�\2.. blot 0 i b 3 9 Alt.Tel.No.: 413 5l0 IctS`�
*Pa M.G.L.c. 147 s.57-61, workreuiresDepartment of Public Safety"S"License: Lic.No.
securityrequires
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 ❑owner's agent.
Owner/Agent
`PERMIT FEE:i
Signature Telephone No. 126-.00
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Z/ 5e(. 11\IS S i
eatirMona sot L./Madtklattaki Official Use Only
a•
tr G Apartment.o f�..). lea Permit No. (/- 1-2— �0 57
..\„.
Occupancy and Fee Checked4/4
BOARD OF FIRE PREVENTION REGULATIONS tRev. 1/0 7] (leave blank)
i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
1 w All work to be performed in accordance with the Massachusetts Electrical Code ),527 CMR 12.00
a
(PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date: 1 L/6 1 Z
City or Town of: No c 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) ,2...k S 5 Q C‘ "A--
Owner or Tenant N &Ve. c ,5c,.-..� Telephone No.613)7?2.-1 i 7 7
Owner's Address "Z el Sul ,-.7 �%
Is this permit in conjunction with a building permit? Yes Er No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ,,,)11 t \a f �,R k, \,,,,
Completion of the followingtable may be waived by the Inspector of Mires.
Total
No.of Recessed Luminaires No.of Cells-Snap.(Paddle)Fans No,of
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swlmrriin Pool Above In- No.of Emergency Lighting
i grad. ❑ grad ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of ,as Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
Na of Waste Dbpasas Heat Pam) Number Tons KW �No.oT Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Ares Heating KW Local❑ l aaultipal 0 Other
Connection
No.of Dryers Heating Appliances KW Security 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 NofDevices
r Wiring:
Na of Devices or Eqivalnt
OTHER:
.teach additional detail if desired or as required by the Inspector of Wires,
Estimated Value of 'cal Work: (When required by municipal policy.)
Work to Start: 2 ti 'i-1— Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: 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 covpige is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
I terrify,under the pains and penalties perf ury,that dire information on this application is owe and complete.
FIRM NAME: ti lea". (r ..��r�'+c� \eAric.:aw L.-LC- LIC.NO.: r
Licensee: A,n." C ,,ate-'\, Signature - LIC.NO,: 114 0 -
(if applicable.enter" "' the a number line) �A, ^^ Bus.Tel.No.:
Address: 2? '-t`k I ,r K{ atK�,,� /"W b l031 Alt.Tel.No.: 43 32° 1q5K
*Per M.G.L.c. 147,s.57-61,security work*quires 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's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ 1'32 .3 v
✓� l� a� (,(1 �i V\
7
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Conunoigwea&0/Mamarksciflis Official Use Only
... -l
; .. Permit No. 2-2- -a Li 3a
,-,-, , 2 li
.. f 'i: spdostaisfil CI 5iPt SOPPICIM 1
it '.
7
, Occupancy and Fee Checked 142,/3 1
... ..3 ‘... BOARD OF FIRE PREVENTION REGULATIONS lRev.11071 (leave blank)
.. ,,.
4•11"
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be nerfonned is ar... raance'with the Massachusetts Electrical Code( ),5.27/CMR 12_00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City
City or Town of: I- 1p,i i..A.4."t To the inspector of Ffires:
By this application the undersigned gives notice of!dice her intention to perform the electrical work described below,
Location(Street&Number) 1..‘5 ISa.f.. S\--
Li ) :.
Owner or Tenant 1•3 r\.\-(, c C't rt.t..-- Telephone No. L'i\:.' 77 2_- l 1 -7
Owner's Address LC-i S ?f'1 vs) Sk c:: C)7 42•••`,14 e.
Is this permit to conjunction with a building permit? Yes L'-'• No 0 (Cheek Appropriate Box)
Purpose of Raiding Utility Authorization No.
—
Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps ,., Volt/ Overhead Li Underd[ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electriral Work: A-f,TS , ,.... ..... ,, D•t.,,. ,-, ,_.:.x, re...,...e( Irk.,_ \ e •,‘
":-
Completion of the follow(, table may he waived by the!superior of Wig-cc.,
-No.of Total
No.of Recessed Luminaires No.of Cell.-,Susp.(Paddk)Fans Transformers KVA
No.of Luminaire Outlets No..of Hot Tubs Generators KVA
Above 0 hi- 1-1 Nu.ni Enierghnq Lighting i
No.of Luminaires Swimming Pool crud. tow& "1 Etattery Units
No.of Receptacle Outlets No.of Oil Bunsen FIRE ALARMS No.of Zones
Si.of Detection and
No.of Switches No.of Gas Banters Initiating Dry kes
Total
No.of Ranges No.of Air Con& No.of Alerting Devices
Tons
'Heat Pump Number Tons KW No.of Self-Contained
;No.of Waste Disposers Totals: Detection/AkrtinzDevices
No.of Dishwashers Space/Area Heating KW Local 0 MunicIP*1 0 Other
Connection
No.of Dryers Heating Appliances KW Security Sysbans:*
No.of Dev ... or Equivalent
No.of Water No.of 1.4o,of
KW Data Wiring:
Heaters Signs Salinas No.of Devices or Equivalent
----------lraectuninsnieatt VMng:
No.flydrotuassage Bathtubs No.of Motors Totalons HP No.of Devices or Equivalent-
OTHER:
Attach additional detail if desfred,or as required M the Inspector of Wires.
Estimated Value of rail?)Wok: (When required by municipal policy.)
Work to Stet*: G 1-5- V-Inspections to be requested in accordance with MEC Rule 10,and upon umipletion.
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
undcrsignal certifies that such cov9ragc it in fcrce,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 2. BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of p-,. t- ry,chat die Information on this application is bate mad complete.
riRm Non:-1; .A.-„,......_ G-a......., A 6\ c ,s, L.Li..., - LIC.NO.:
...7, .
l irensee: \ k e, 04. (Cas...„.: 6,,,,k Signature .... .-"-- -,...? LIC.NO.:
.k._
Of applicable,eater emPl,"iikdfe licesue nsimAer tur) • I l lists.TeL N•.:t.(3 Z14.) •V(t*;
Address: 17 r'w s f Ai e\„3., A .,, Wa,V1/41....")% ; Nt 10 At C k c...:34'0 Att.TeL No.:
Per M.G.L.c. 147,&57-61,security work renlikes Department of Public Safety"S"License: Lie.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)Ej owner Downer';agent.
Owner/Agent
Signature Telephone No. PERMIT PEE:$ 2,1 '. re
/kJ0) 1 b cC
1711 -271)7)j, liCr9-11
C(x'_7rl 3 /f b I ' 0 —
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY _Northampton MA DATE 4/20/23 PERMIT# Pr-2,02"; —0ii1
JOB 5 DDRESS 215 S rin St OWNER'S NAME Nate Fri and
OW DDRESS TEL 1FAX
PE OR OCCUP41CY TYPE COMMERCIAL 1 EDUCATIONAL i RESIDENTIAL I
PRINT
LEARLY NEW: RENOVATION:[ REPLACEMENT:[ PLANS SUBMITTED: YES E,'LI NO
N --
FIXTURES 1 ,_FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) — — --- ---
KITCHEN SINK _ L i v _ •
LAVATORY OH I. A ME
ROOF DRAIN ' • APrP OvED
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER Trench drain 1
IL—
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES E NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance II Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Paul Graham LICENSE# 12322r.
SIGNATU
MPEJ JP[-„ CORPORATION p# P. ARTNERSHIPD#f 1LLC0#�
COMPANY NAME!Paul's Plumbing&Heating —1 ADDRESS P.O. Box 303
CITY Huntington STATE L MA ZIP 101050 TEL 413-238-0303
FAX I —�CELL 413-626-2745 3 EMAIL paulsplgxhtg@aol.com
7--A/-6
c/ 2/3 3 ' „,,,Q-.0 G
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY~ k� r� MA DATE i .5'/y7, PERMIT#�P-?� '"d t 8
_i gOBSITE ADDRESS ,. /5 sr OWNERS' NAME f�, � ci
POWNER AD RESS 1 TEL FAX I
1
TYPE OR OCCUPANC TYPE COMMERCIAL 1 EDUCATIONAL RESIDENTIAL j
PRINT -t
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
FIXTURES 1 FLOOR-i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB "
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM _
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK F'Lllftri`•irV("a & GAS I(�#�,r+F ,f Fn
LAVATORY 3- N O-RTI hA IVI PTO 4
ROOF DRAIN SHOWER STALL .-'af`F`'I rt:0 NIT fi TT )
SERVICE/MA
MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES I
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES . NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY , OTHER TYPE OF INDEMNITY BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac rate to the best of may knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,
PLUMBER'S NAME Paul Graham ., j LICENSE# 12322 SIGNATURE
MP , JPL_ CORPORATION De- PARTNERSHIP®# __ ILLCE#,
COMPANY NAME I Paul's Plumbing&Heating 1 ADDRESS P.O. Box 303
CITY Huntington STATE MA ZIP 01050 TEL 413 238-0303
FAX CELL 413-626-2745 EMAIL paulsplgxhtg@aol.com I
7
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Commonwealth of Massachusetts
MAURA HEALEY LAYLA R.D'EMILIA
GOVERNOR Division of Occupational Licensure
UNDERSECRETARY,CONSUMER
KIM DRISCOLL
1000 Washington Street, Suite 710 AFFAIREGULA BUSINESS
LIEUTENANT Governor Boston, Massachusetts 02118
SARAH R.WILKINSON
COMMISSIONER,DIVISION OF
OCCUPATIONAL UCENSURE
YVONNE HAO
SECRETARY,HOUSING AND
ECONOMIC DEVELOPMENT
05/08/2023
Paul Graham
P.O. Box 303, Huntington, MA 01050
Re: 23-PV-380, 215 Spring Street, Florence, MA
Dear Mr. Graham,
Please be advised that on May 3, at 9:00 a.m. the Board of State Examiners of Plumbers and Gas
Fitters held a remote board meeting where they deliberated on and voted to grant a variance from
248 CMR 3.04(1)Board Required Product Acceptance-55-gallon drum sediment filter
10.02 (26)Materials and Design
10.05(15) Connections to Plumbing System Required
10.06 Materials
10.09 Interceptors, Separators and Holding Tanks
For the design of a vegetable washroom which has one large trough drain that drains to daylight
on their property.
This variance decision is based on the presentation, information and documentation provided by
the applicant and is applicable to this end user and this site only. All other plumbing and gas
fitting work if applicable shall comply with the rules and regulations of 248 CMR 3.00 through
10.00 and all other applicable statutes and codes.
Sincerely, For the Board,
Kenneth Peterson
Executive Director
Board of State Examiners of Plumbers and Gasfitters
CC: Larry Eldridge, Plumbing and Gas Inspector
TELEPHONE: (617) 701-8600 FAX: (617)701-8658 TTY/TDD: (617)701-8645 http://www.mass.gov/dpl
2/5- 5Pt) n/' Si �/a� BB[/ y1�t� ff
C..oitwcoaweallh al 1/laJeacicuaetfe Official Use Only I
` . .; Apartment c�� Permit No. fly-�23 -0( 4S
,.y ,,_ ,.tiro Serviced
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] eave blank ' =
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
_, All work to be performed in accordance with the Massachusetts Electrical Code( C), 27 CMR 12.00
(LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i IDS 23
City or Town of: 1.3 0 si-.t-\pa..-tiQ� \-0.- 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) 2\c S?( 1 S c
Owner or Tenant `V ek_\-Z f\3 N-& Telephone No. Lck a -7 7 Z-\'ct 7
Owner's Address '201 S 2(k 1 54 c.`nre ce-
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
New Service Amps / Volts Overhead 0 Undgrd 0 No,of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ,) t e. Z fie_,,,./ )a-A'�r ccie,-,5
Completion of the followingiable may be waived by the In�sppector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grad, grad. Battery Units
1
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas BurnersNo.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.o f AlertingDevices
Tons
Na of Waste Disposers Heat Pump Number Tons kW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent y
No.of Water Kam, No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications NDevices
quing
Na.of Devices or Equivalent
OTHER:
Attach additional detail if des ired or as required by the Inspector of Wires.
Estimated Value of,Electrical Work: (When required by municipal policy.)
Work to Start. 7 2 i// L I Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unlesswaived 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 Eiji BOND 0 OTHER 0 (Specify:)
1 certify,under the pains and penalties of pedury,that Ire information on this application is true and complete.
FIRM NAME: �,A.,&.,` CrTx,,.i {�-o•-, E.\e.c)'-c i,,,`,,,,\. L.\-C.- LIC.NO.:
Licensee: 17, A...a✓. (' -0'10-& Signature LIC.NO.: 1%,O(. - 3
(If applicable.enter"exfmpt"in the license nwtitter line)1 Bus.Tel.No.: lt3 3 Lo • \ "SY
Address: 2:7 r c re\.t AC H e.-..A../:l f, M c,viSci 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 ❑owner's agent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE: $ \ 1-5.
\-1V /s �� - - 6
\-0 1 f Oc £e >re - Z.