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S. Smith Electrical Permit Application圃 乙肋ルル。。勧夕物納ん。勉 励㍗巌布佐疑義′ui。。d 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