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tiyR))idurr:
1 vi.% Paid: sI I41.110
217 P/kR K J//I%G. fW
- Commonwealth of Iieasssachasei s Official Use Only
_-i T. �- D 37 C
7 l }-=. U Tip e_ Permit NO- 2 j
' , Department of Fire Sets/cGs
: y �� Occupancy and Fee Checked 1y`�q
_: . -_. ' t� �QOARD OF FIRE PREVENTION REGULATIONS [Rev_11/99] (leave blank)
• u U
� � r to �.`- F[_ '� r,:. �i WORK
PPLICATiON FOR`ERMI t t O PERFORM ELECTRICAL��Or K
r..7 All tcvrk to be performed in accordance with the A sarhuseris Electrical Code(MEC),527 CMR 12.00
0
(PLi 'SE P iT IN INK OR LIFE ALL INFORMATION) Date: S - I I -" 2 2.
City Or. Town of N 0 r t h a m P 1 n To the Inspector of Wires:
N By this a�plieatio the undersigned gives nofice of his or her intention to perform the electrical work described fbeiow. o t p z
Loc,.t`t"a$� i J&Number) 2 1 1 r c( r V 1-if I ( IZ G ct of Nor+ h a m p l-u , M a
Owner or Tenant 5're lie (n U h ct K e b t([of T u (" 1 (5 I Telephone No. g I La L) b --
Clwner's Address -2 1 ( PO r K H t 1 I IQ 6 C t O1 -7 b 3 (p
is this permit in conjunction with a building permit? Yes Fr Na ❑ (Check!-appropriate Box)
Purpose of Building Utility Authorization No. 3 1 - 2 O �,2 - O 9 q2
Eurting Service 2 6 0 Amps (2 0 / 2 4 D Vohs Overhead Cl Undgrd❑ Ito.of Meters I
New Service Amps / Volts Overhead 0 Undue❑ No.of Metiers
Number of Feeders and Ampacity
Location and Nature of Proposed Electriizl Work: fj C(t h r 0 c t'1 re Yr o del ( b i Cf 1 W O f I
-
Completion of the following table may be waived by thei Inspzctar of Wires
No.of Recessed Fixtures Ires � o_of Ceil.-Suss(Paddle)Fans no_of_ i Total 1 i renstorterc ' KVA
No.of Lig tag Outlets !No.of Eat Tubs Generators jCVA
No.of Ugbting Fixtures isivi*rtrning Pool A2n}ove ❑ lIt- ❑ No.of Emergency.t.dg.rag
grad, ernd. Buttery Units
No.of Receptacle Outlets J2 o.of Oil Burners • 31 E ALARMS No.of Zones
No.of Switchr INo.of Gas-Burners Hugo_of L Ctecfion and i
T_uimnQ Devices I
Total
No.of ages )No.of Air Conn. Tons °No.of Alerting Device
No.of W �
Rest-Pump _Numzber Tons } c�lo.of Self-Contained
I�sresers _ Totals: 1 1 i t iou/Alertia.Devices
❑ Municipal No.of Dishwashersasers space/Area IicaLiztg KW !Local0 Other
Connector':
No.of Dryers IHea Applees KW Seeurit-yS' errs:
No.of Devices or Ece=:atent
No_of Water eata K, No.of No.of somata Wiring:
r Fd
S��us Ba Colo No.oT Devices or'eatn:alent
T ecolumunicft IlV •:ors Wi �:
1`�,a. } Fo.0 ge Bathtubs No:of Motors To F P No.of Devices or E lent
I• Attach additional detail ifdesire4 or as required by the Inspector of lVzres.r
DIS-tIF.ANCE COVElz-AGE: Unless waved by the owner,no permit for the performance of elect ical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its sabstanuial equivalent The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office_
CI-TE :K.ONE: INSURANCE K BOND ❑ OTHER ❑ (Specify:)
(E..-piratioa Date)
Estimated Value of Electrical Wo-1L (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with Iv EC Rule 10,and upon Completion
I ,under the pains and peirelties of pe<jz y,L.t the info ,.rsien on this applecct`iotz is&ee erd crnple1e
FIRM NAME:S G\ Ot v fl in; ti a I( f G (e C I. C c( I Cu at. L 1, (, 1 C T O.: 22 I i 8 - H
Licensee: S f'(\V N -lam) PrC.E► ) Sigatur LIC.NO.: 5 S , 1 I — 3
0-applicable, pt"in the license num er li ) Bess.'.I eI.NNi . gr 3
Address: iid (, 'Dii�.� C L�1' Aft TeL N .. 1D
OWNER'S I NSURANCE WAIVER: Elam aware that the Licensee Noes not have the liability insurance .p ly
required by law. By my signature below,I hereby waive this requirement_ I am the(check one)[]owner. ❑owner's agent
Owner/Agent PERT 'E:$6,j''
Signature - Telephone No.
,,,,,v •,i i tee - 8-lo
(M2N1/ 4380
sZ, MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK
► /
.��~` CITY n c'C�c.,.., k 0"1 MA DATE.5✓-41V42a PERMIT# ?(.P--Z022" 621)3
JOBSITE ADDRESS a t PC C1,1, 1 OWNER'S NAME `NYC J 6.) ✓, I(I;I..
POWNER ADDRESS C.Se..i.V.. TELiii -e)i,S-3S3.j ,�,FFAX_'
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL Ind
PRINT
CLEARLY NEW:0 RENOVATION:Er REPLACEMENT:0 PLANS SUBMITTED: YES 0
FIXTURES i FLOOR—' BSM 1 2 3 4 5 6 / 8 9 10 11 _ 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
1 DEDICATED GASJOILISAND SYSTEM
' DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER ,
FLOOR i AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK PLUMBING 4 GAS INSPECTOR
LAVATORY p1. jVO{NTHAMP'ON
ROOF DRAIN APPROVED NOT APPROVED
SHOWER STALL I
;��'
SERVICE i MOP SINK ?/ .
TOILET
URINAL
WASHING MACHINE CONNECTION _ I
WATER HEATER ALL TYPES ,
WATER PIPING
OTHER f 1
I
I
—,__ i Ili
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES( NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY EK OTHER TYPE OF INDEMNITY ❑ EDt D ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chaptet 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 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 a rate to the best of my knowledge
and teat all plumbing work and installations performed under the permit issued for this application will be in compllapCC h all Pe prevision of the
Massachusetts State Plumb' g Code ap Chapter 142 of the General Laws.
PLUMBER'S NAME ' LICENSE# 3,i,701 SIGNATURE
MP❑ JP 12' CORPORATION 0# PARTNERSHIP 0# LLC❑#
COMPANY NAME%let ne it ADDRESS 7 DA'.D S7
V/3 3A7-7�
CITY �' "*/�..•,�,�i -_-- STATE /''Y! ZIP �.f o'jJ TEL 7
FAX CELL EMAIL
6- /7/. ar.64 fren6, 75E
25$-
,