HomeMy WebLinkAboutElectrical Permit ��,��� � LL',�>��
Commonwealth of or��sa�u�o��Y
a Z ���15�q Massachusetts pe��tN°. B�oe-�s-oo�s�s
' i-�E�B(JA'RD' IRE PREVENTION REGiJLATIONS Occupancy and Fee Checked �
v.1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfortned in accordance with the Messachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINTININKOR TYPEALL INFORMATION) D8Y¢:9/21/2015
City or Town o$ YARMOUTH To rhe�nspec:o.ojwires:
By this application the undttsigned gives no ce o is or er m n on o pe orm e e ec c worlc described below. ..
Location(Street&Number) 38 HOLLY LN .
Owner or Tenant MURPHY JOHN W Telephone No.
Owner's Address GIRARD KAREN E,6 FRANKLIN DR,TYNGSBORO, MA 01879
Is this permit in coojunctioo with a building permit? Yes ❑ No ❑ (Check Appropriate Bax)
, Purpose of Building Utility Authorization Na � � �
Eaisting Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters �
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters�
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Septic alaRn&sys�em
Completion of the following table may be waived by the/nspector of A'ires.
No.o[Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transform rs KVA �
No.of Luminaire Outlets No.of Hot Tubs Generetors KVA
No.ofLuminaires Swimming Pool ACoa e � I�oa � No.otEmergency Lighting �
Ba nit
No.otReceptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones �
No.ot Switches No.of Gas Buroers No.of Detection and G
� Initiatin Devices (n
No.otRsnges No.of Air Cond. Toos� No.of Alerting Devices �
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �
Totals: Detectlon/AlerNn Devices
No.of Dis6washers Spsce/Area Hea6ng KW Local ❑ Municipal p Ot6er: �
ConneMion
No.of Dryers Heating Applisnces KW Securily Systems:•
No.ofDevi es or E uivaknt
No.of Water K�y Na of No.of Data Wiriog:
s Si ns No.of Devices or E uivaknt
No.Hydromassage Bathtubs No.otMotors 1 Total NP � Telecommunieations Wiring:
No.of Device r E i 1
OTHER:
Atrach additiorm!detarl ijdes"ved,or as reguired by thelnspector of Wrres.
Estimated Value of Electrical Work: (When requ'ved by municipal policy.)
Work to start: Inspecfion to be iequested in accordance with MEC Rule]0,and upon completion.
INSURANCE CO VERAGE:Unless waived by the owner,no permit for the pedormance of electrical work may issue unless the licensee
provides proof of IiabiliTy insurance including"completed operatiod'coverage or its subs[anfial equivalent.The undersigned certifies that such
coverage is in fome,and t�as e�ibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTI-IER O (Specify:)
/cer(ijy,under the poins and penaNia ojpery'ury,that the information on this aPplicaHon is true and comp[e[a
FIRM NAME: REX BURGER ELECTRICAL INC
Licensee: A J PULLEY Signature LIC.NO.: 21843
(IjapP7icable.enter"uemp["in the license mimber line.) Bus.Tel.No.:
Address:2045 MAIN STREET, MARSTONS MILLS MA 02648 Alt.Tel.No.:
•Per M.G.L.c.147,s.57-61,securiTy work requ'ves Departrnent of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally requ'ved by law.But
signature below,l he�eby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent
Owner/Agent
Signature Telephone Na PERMIT FEE:$50.00
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