32C-174 (7) Office Use Onl
�6llL9lC�fLZG�C�ZGI/l/E /ci��C�ld011C/lll�P.� Permit No.
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BOARD OF FIRE PREVENTION REGULATIONS FPR-11, RULE a Effective 1/1/78
APPLICATION FOR PERMIT TO PERFORM Q.ECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, PPR-11
Date 71� o?4 19,s'
City or Town of
To the Inspector of Wirest The undersigned applies for a permit to perform the electrical work described below.
Location (Street a Number) ,20A .0-As�-Q/,,. /— 5,<VrQ'e - Pole No.
Owner er-'Par�at De on f'Trf D s P/9/�TG <�/� /k/s
owner's Address i e e
Ss this permit in conjunction with a building permit? Yee No
Purpose of Huil
Service Amps 12-0 2' volts No. of M6ters 07C-e--
E�doting New Y�o
reamed fsL to
Nature of the Proposed Hlectrical York
PROPOSM FIrMrj S IN DMIL (See attached schedule, if n•eess=T)
Location of Room OLights Fix
Sw. Plugs t Location of Room Outlets Sw. Plugs Fitt.
No. of Sw. Out. Reat - T"9
NQ. foutiets 4t. Oil
No. of R
o. of Motors Electra - KW Comnected. Load
o. S ens t Water - Hoto Si s*
r Con, Steam Motors and Si •
Rome Name pl a rate Hot Air motors and Siz e 'A 1i
Water Heater Nahe Diets rate Misc.
Clothes er Name Plate rate I I--4
RV-Load
i e o Entrance
Size of S Conductorg
Work j Start Inspection Dab Requested .C.[J ! Permit Fee���
Signed under the Pena tie• of P•rjurys
Licensee cJ0���1 �� u) C: Si�aturs - License No. G
Pl•ss• print P • sign
Address dlJ�C� _ J�G�, /(/O D�h . ()!O l n Tel No. 4., 72 a Y'
(Street ! Number) (pity or Two) (Zip Cc")
Supplemental information on forms furnished by the inspectors of wires shall be nailed or delivered by the opplioant
within five (5) working days from the date of said applicatisa, if required by the iospeotor of wires.