FDF-SED 2011 PermitOfficial Use Only
P1
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
Date
1/19/2011
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of: SALEMTo the Inspector of Wires
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
102 SCHOOL STREET
Location (Street & No)
TINA VARGAS
Telephone
Owner or Tenant:
:
Owner's Address
Is this permit in conjunction with a building permit?YesNo( Check Appropriate Box)
SINGLE FAMILY
Purpose of BuildingUtility Authorization No.
100120240
VoltsOverheandUndgrdNo. of Meters
Existing ServiceAmps
VoltsOverheandUndgrdNo. of Meters
Amps
New Service
Number of Feeders and Ampacity
WIRE REPLACEMENT OF H W BOILER IN BASEMENT
Location and Nature of Proposed Electrical Work :
Completion of the following table may be waived by the Inspector of Wires.
No. ofTotal
No. of Recessed Luminaries
No. of Cell-Susp. (Paddle) Fans
TransformersKVA
No. Luminarie Outlets
No. of Hot TubsGenerators
KVA
No. of Emergency Lightning
No. of Luminaries
Above grndIn grnd
Swimming Pool
Battery Units
No. of Receptacle Outlets
No. of Oil Burners FIRE ALARMS/
No. of Zones
No. of Dedication and
No. of Switches
No. of Gas Burners
Initiating Devices
Total
No. of Ranges
No. of Alerting Devices
No. of Air Cond.
Tons
Heat PumpNo. of Self-Contained
No. of Waste Disposers
NoTonsKW
Totals :Detection/Alerting Devices
Municipal
No. of Dishwashers
LocalOther
Space / Area Heating KW
Connection
Security Systems
No. of Dryers
KW
Heating Appliances
No. of Devices or Equivalent
Data Wiring:
KW
No. of Water HeatersNo. of SignsNo. of Baliasts
No. of Devices or Equivalent
Telecommunications Wiring
No. of Hydromassage BathtubsNo. of MotorsTotal HP
No. of Devices or Equivalent
OTHER
Attach additional details if desired or as required by the Inspector of Wires.
300.00
Estimated Value of Electrical Work
(When required bu municipal policy)
READY
Work to StartInspections 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:(Specify):
INSURANCEBONDOTHER
I certify, Under the pains and penalties of perjury, that the information on this application is true and complete..
17478A
LIC NO.:
G W SANBORN & ASSOC
FIRST NAME:
33423E
LIC NO.:
Licensee
GEORGE SANBORN
Signature
Bus. Tel No:
800-329-8256
(If applicable, enter "exempt" in the license number line.).
P O BOX 332 PEABODY MA 01960
Alt. Tel No:
978-833-7369
Address
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
OwnerOwners Agent
I am the (check one)
15.00
PERMIT FEE:$
Tel No.
Owners Agent Signature
P2
Official Use
Only
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) ( leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
1/19/2011
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
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
Only
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) ( leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
1/19/2011
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
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
Only
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) ( leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
1/19/2011
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
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
Only
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) ( leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
1/19/2011
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
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
Only
Commonwealth of Massachusetts
401
Permit No.
Department of Fire Services
Occupancy and Fee Checked
( Rev. 1/07) ( leave blank)
BOARD OF FIRE PREVENTION REGULATIONS
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
1/19/2011
Date
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
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