HomeMy WebLinkAboutElectrical Permit _� Commonwealth of Official Use Only
� ��� Massachusetts PermitNo. BLDE-15-00588
' BOARD OF FIRE PREVENTION REGULATIONS -Occupancy and Fee Checked �' ���{—�����
. Rev.1/07 � `
APPLICATION FOR PERMIT TO PERFORM ELECTRI AL W
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 C 1���,T� ���1�
� (PLEASE PRINT IN INKOR TYPE ALL lNFORMATION) DeYO:5/28/2015
City OI'TOW�Of: YARMOUTH To the/nspectorojWires:
i By this application the undersigned gives n ce o �s or er m n on o pe orm e e ectnc work described below.
Location(Street&Number) 58 NANTUCKET AVE
Owner or Tenant GEARY PATRICIA R Telephone No.
Owner's Address 605 MIDDLE ST UNIT 5, BRAINTREE, MA 02184
i Is this permit in cmjuocNon with a building permit? Yes ❑ No ❑ C6eck A
Pur ose of Buildin � ppropriate Boa
P S Otility Authorizafion No.
jEzisting Service Amps Volts Over6ead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
� Number of Feeders and Ampacity
I.ocation and Nature of Proposed Electncal Work: SeptiC System
1
i
� Completiors af the following table may be waived by the Inspector ojWires.
! ' No.of Recessed Luminaira No.of CeiL-Susp.(Paddle)Faus No.of Totai
Tnn formers KVq
No.otLuminaire OuHets No.of Hot Tubs Generators KVq
No.ofLuminaires Swimming Pool A�a e � I'�d � No.otEmergency Lighting
Batte Units
No.of Receptacle Outlets No.of Oii Burners FIRE ALARMS No.of Zones
No.af Switches No.of Gas Burners No.of Detection and
Inkiatin Devices
No.of Ranges No.of Air Cond. .Tr003� No.of Alerting Devices
� No.of Wash Disposers Heat Pump Number Tons KW No.of Sdf-Contained �
Totals: Detectioo/Alertin Devices
No.of Dishwashers Space/Area Heating KW L�� p Municipal p Other:
Coonectioo
No.of Dryers Heating Appliances KW Security Systems:•
� No of bevices or E uivalrnt
No.of Water KW No.of No.of Data Wiring:
Heaters Si ns Ballasts No.of Devices or E uivalent
No.Aydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devi es or E uiv leot
OTHER:
Attach additiaw[demii if desired,or ns regvired 6y the/nspector af Wires.
Estimated Value of Electrical Work: (When requ'ved by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 1Q and upon comptetioa
INSURANCE CO VERAGE:Unless waived by the owner,no pemiit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including"complered operatiod'coverage or its substantial equivalent.The undersigned certifies that such
coverage is in foroe,and has e�ibited proof of same to the permit issuing o�ce.
CHECK ONE:INSURANCE ❑ BOND ❑ OTI-IER ❑ (Specify:)
I cer[ify,under the pains and penakies oJperjury,that the rnjormation on this application is bue artd complde -
FIRM NAME: DANIEL 0 WILKEY
Licensee: DANIEL 0 WILKEY Signature LIC.NO.: 32288
(�.loPPlrcable,en[er"e.xempP'in the Jicense number 7rne.J Bus.Tel.No.: -
Address: 168 CENTER ST, SOUTH DENNIS MA 02660 Alt.Tel.No.:
'Per M.G.L.c. 147,s.57-61,security work requires Deparlment of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am awa�e that the License does not have the]iability insurance coverage nom�ally requ'ved by law.But
si�ature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owne�'s agent � .
Owner/Agent
Sigoature Telephone No. PERMIT FEE:$50.00
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