FDF-SED 2013 Permit P1 Commonwealth of Wassachusetts Permit No. Official Use Only
r. 403
Department of Fire Services
Occupancy and Fee Checked
' BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
j,
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM 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&No) 15 WARREN STREET
Owner or Tenant: KATHERINE MILLER Telephone 978-744-8140
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building RESIDENCE Utility Authorization No.
Existing Service Amps 1 Volts Overheand ❑ Undgrd ❑ No. of Meters
New Service Amps 1 Volts Overheand ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work : CONNECT REPLACEMENT
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaries No.of Total
No. of CeIlSusp. (Paddle) Fans
Transformers KVA
No. Luminarie Outlets No. of Hot Tubs Generators KVA
No.of Luminaries Swimming Pool Above grnd In gd No.of Emergency Lightning
❑ rn ❑ Battery Units
No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS/No.of Zones
No.of Switches No. of Gas Burners No.of Dedication and
Initiating Devices
No.of Ranges No. of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump No 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-
No.of Water Heaters KW No. of Signs No.of Baliasts Data Wiring:
No.of Devices or Equivalent
No.of Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring
No.of Devices or Equivalent
OTHER
Attach additional details if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work (When required bu municipal policy)
Work to Start Inspections to be required in accordance with MEC Rule 10,and upon.Completion
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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑X BOND ❑ OTHER ❑ (Specify):
I certify,Under the pains and penalties of perjury,that the information on this application is true and complete..
LIC NO.: A9982
FIRST NAME: MACOMBERS 1 , INC
LIC NO.: E24739
Licensee RICHARD K MACOMBER Signature
(If applicable,enter"exempt"in the license number line.). Bus.Tel No: 781-631-5131
Address Alt.Tel No: 781-632-9097
Per M.G.L.c, 147,s, 57-61,security work requires Department of Public Safety "S" License: Lic.No:
OWNERS 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) owner ❑ Owners Agent ❑ PERMIT FEE:$ 15.00
Owners Agent Signature Tel No.
P2
Official Use
Commonwealth of JYLassachusetts Permit No. 403
A Department of Fire Services Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM To the Inspector of Wires
The fee for new work ( new construction or repairs ) shall be three dollars ( $3 ) per one thousand dollars ( $1,000.00 ) of
the valuation as shown on the building permit. Fee schedules available upon request Each permit$15.00 minimum
P3
Official Use
Commonwealth of JYLassachusetts Permit No. 403
A Department of Fire Services Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM To the Inspector of Wires
The fee for new work ( new construction or repairs ) shall be three dollars ( $3 ) per one thousand dollars ( $1,000.00 ) of
the valuation as shown on the building permit. Fee schedules available upon request Each permit$15.00 minimum
P4
Official Use
Commonwealth of JYLassachusetts Permit No. 403
A Department of Fire Services Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM To the Inspector of Wires
The fee for new work ( new construction or repairs ) shall be three dollars ( $3 ) per one thousand dollars ( $1,000.00 ) of
the valuation as shown on the building permit. Fee schedules available upon request Each permit$15.00 minimum
P5
Official Use
Commonwealth of JYLassachusetts Permit No. 403
A Department of Fire Services Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM To the Inspector of Wires
The fee for new work ( new construction or repairs ) shall be three dollars ( $3 ) per one thousand dollars ( $1,000.00 ) of
the valuation as shown on the building permit. Fee schedules available upon request Each permit$15.00 minimum
P6
Official Use
Commonwealth of JYLassachusetts Permit No. 403
A Department of Fire Services Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev.1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1/30/2013
City or Town of: SALEM To the Inspector of Wires
The fee for new work ( new construction or repairs ) shall be three dollars ( $3 ) per one thousand dollars ( $1,000.00 ) of
the valuation as shown on the building permit. Fee schedules available upon request Each permit$15.00 minimum