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0023 ABAM STREET - Electrical Permit 547 INSURANCE WAIVER . . . . . . . . YES . . . . . . . . . . . . . NO. . . . . .}� City of Salem - City Electrician V NO. :.��. . . . . . . . . . . . . . B.P.#. . . . . . . . . . . . . FEE. . . . . . .... .... . . . . . . . . . . . . . . . . . APPLICATION FOR WIRING PERMIT "ROUGH INSP . . . . . . . . . . . . . . . . . . . . . . . . . FINAL INSP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Lafayette Street SIGN INSP. .,•. . . . . . . . . . . . . . . . . . . . . . . BURNER INSP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Salem, MA 01970 RE-INSP. . . . . . . ./ . . . . NO ACCESS/FILED. . . . . . . . . . . . . . 978-745-6300 SERV. INSR��o?,L��� LITY AUTHORIZATION#.�:9L �.� : : : . : : : . . . . : FaX 978-745-4638 M.E.N. DATES O Date work to dommenc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .to wire premises at CHECK WORK TO BE DONE Street and No. ,�,3 . . - . . . . . . . . .VO I D- O N E Y EAR . New Work [ ' Owner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Old Work [ ] Occupied by. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FR.OM. DATE.OF.PERMIT Service o v- Used for Dwelling. . . . .7 .Condos . . . . . . . . . . Industrial . . . . . . . . .Commercial . . . . . . . . . No. of Meters Wiring Service: New . . . . . . . . . . . . . . . . . . . . . . .Temporary . . . . . . . . . . . . . . . . . . . . . . . . . . . Electric Sign Service change from. . . . . . . . . . . . . . . .Amp to. . . . . . . . . . . . . . . .Amp . . . . . . . . . . . . . . . . . Gas Pump Service Grounded to . . . . . . . . . . . . . . . . . . . . . . . Ground Size. . . . . . . . . . . . . . . . . . . . . . . . . . Swimming Pools/Tu_b tP [ ] Single Phase . . . . . . . . . . . . . . . . . .3 Phase. . ... . . . . . . . . . . .3 Phase,4 Wire. . . . . . . . . . . . Voice Data Outlets Y [ ] How Installed: Conduit. . . . . . . . . . . . . . . . . . . . . .S.E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Range 37 Overhead . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . Underground . . . . . . . . . . . . . . . . . . . . . . : . . Water- Heater Q [ ] Existing Service: Electrically and mechanically good condition?. . . . . . . . . . . . . . . . . . . . . . . . . . . Dryer [ ] Gas-Oil.Burner Signature of Applicant. . . . . . . . 9 [ ] Firm's Name. . . . . . . . . . . . . . . . . . . . . . . . . . Oil Burner Tech #. . . . . . . . . . . . . . . . . . . . No. of Circuits *' [ ] Firm's Telephone No.. . . . . . . . . . . . . . . . . . . .Lic. No. E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. of Fixtures [ ] Street No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Firm's Lic. No. E . . . . . . . . . . . . . . . . . . . . . . . . . No. of Receptacles [ ] City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Master Firm's Lic.A. . . . . . . . . . . . . . . . . . . . . . . No. of Motors [ ] Ready for-first inspection . . . . . . . . . . . . . . . . . Lic. No.C. . . . . . . . . . . Lic. No. D . . . . . . . . . . . Electric Heat [ ] Lic. No.A or C. . . . . . . . . . . . . . . . . . . . . . . . . . . Fire Alarm System [ l NOTE:Wire must not be covered in without permission.This card to be filled out before Burglar Alarm [ ] work commenced. Notify this office at the completion of all work including finish. Smoke Detectors [ ] All captions shall be filled in COMPLETELY. NOTATIONS ON BACK. . HVAC Units [ ] The fee for new work (new construction or repairs) shall be three dollars ($3.00) 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 C'ommonwaa1dL of Ma4jac4uealb Oflicial Use Only- ` 2tt%%�� cc�7 Permit No. aparin►e'd o/.}ira �arvice� ,IT Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(IIEC),527 CAi 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFOR�1 A710N) Dnlc: C0/ 9�03 City or Town of: Sa&—on 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 R Number) 23 AZ!2rtl �S l/, Owner or Tenant 4' / r �/A Telephone No. 5?p �� 2 Owner's Address 3 AL 6 Is this permit in conjunction with n buildinb permit? Yes ❑ No N (Check Appropriate Box) Purl►ose of Building Utility Authorization No., 10 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters . New Service 2490 An►ps Volts Overhead Undgrd ❑ No.of irleters Number of Feeders and Ampacity .Location and Nature of Proposed Electrical Work: Completion ofdre olluuinQ table may be n•aived be the lns'cctor of)Mires. No.of total No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans Transformers KVA No. of Lighting Outlets No.of blot Tubs Generators KVA Above In, o.o mergency rg ►ting No. of Lighting Fixtures S��imming Pool rnd. ❑ rnd. ❑ Batte Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ► o.of Detection and No.of Switches. No.or Gas Burners Initiating Devices Total iVo.of Ranges No.or Air Cond. Tons No.of Alerting Devices heat Pump i.umber 'Tons_ �____ No.or Self-Contained No. of Waste Disposers Totals: __ Detect ion/Alertino Devices lylunicipal No. of Dishivashcrs Sp:( Area Heating KW Local ❑ Connection El Other Heating;Appliances Key Security Systems- No. of Dryers No.or Devices or Equivalent o. of Water IC�V t o.of No.of Daln Wiring: Heaters Sins Ballasts No.of Devices or E uivalent 1 clecommunicatio� irurg: No. Hydromassage Bathtubs No.of Motors Total IIP No.of Devices or F uivalent — 'OTHER: Attach additional detail if desired,or as required bythe Inspector of lVires. 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 BOND ❑ OTHER ❑ (Specify:) (Expiration Date) �i Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: (i,' S ]nspections to be requested in accordance with MEC Rule 10,and upon completion. I cer•tify,.tin(let-the pains and penalties of petjurY,111r11 the information oil this application is true and complete. hlWNI�'�NAML: r LIC.NO.: I Liceris c: /� Signature LIC.NO.: 3 9 qV (If applicable, enter "ci. np!"in the lirnse numb r line.) Bus.Tel.No.: ` - Address: Y/49" /A. , )WiiA/ '5,7— /��i�/�DUy �/� �l y�� Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coy-crag normally required by law. By my signattue below, I hereby%v ive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/t f , Y p` Pj:Ri111T Ff- : S Signature\;ent K l/c D'C Telephone\o(ld{)`�;) g