HomeMy WebLinkAboutElectrical Permit a
Commonwealth of oe���a�u5e o��y
� � Massachusetts PermitNo. BLDE-15-005049
�' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �
ev.1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
� All work to be perfortned in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN/NK OR TYPE ALL INFORMAT/ON) DatC:4/14/2015
CityorTownof: YARMOUTH TotJre/nspectorofWires:
By this application the undersigned gives nonce o �s or er m en on o pe orm e e ec ca work described below.
Locafion(Street&Number) 8 NEWBURY ST
Owner or Tenant GROVES DAVID I � Telephone No.
Owner's Address GROVES SANDRA B, 204 PINE ST, RP,YNHAM, MA 02767-1149
Is this permit in conjunctioo with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorizallon No.
Existiog Service Amps � Volts Overhead ❑ Undgrd ❑ No.o£Mehrs
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity �
Locatioo and Nature of Proposed Electrical Work: Septic system inStallaGon �
� Completion of the jollowing table may be waived by the Inspectar of Wires.
No.otRecessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Tran formers ItVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.ot Luminaires Swimming Pooi ��a e � I'nd � No.of Emergency Lighting
Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Inrtiatin Devices �
No.of Ranges No.of Air Cond. Total No.ofAlerting Devices
Tons
No.of Waste Disposers Heat Pump Number Toos KW No.of Self-Contained �
Totals: Detection/Alertio Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
Connecfioo
No.of Dryers Heafing Appliances gW Security Systems:*
No. f bevices or E uivalent �
No.of Water �, No.of No.of Data Wiring: �
Heaters Si ns Ballasts N . f Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiriog:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired.or os reqvired by the fttspector orWires.
Es[unated Value of Electrical Work: (When required by municipal policyJ
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
INSUR4NCE COVERAGE:Unless waived by the owner,no permit for the perfortnance of eleclrical work may issue unless[he licensee
provides proof of liabiliTy insurance including"completed operatiod'coverage or its substaritial equivalent.The undersigned certifies that such
coverage is in fome,and has eacliibited proof of same to the pe�mit issuing office.
CHECK ONE:IN5URANCE ❑ BOND ❑ OTHER ❑ (Specify:)
7 certijy,uxder the pains and penaUies ojperjury,lhat the injormation on lhis application is true and comp[ete
FIRM NAME: THOMAS M CRAFTS
Licensee: THOMAS M CRAFTS Signature LIC.NO.: 31520
(lfapp/icab[e,enrer"exempt"in the license nwnber line.J Bus.Tel.No.:
Address: PO BOX 627,W HARWICH MA 02671 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,securiTy work requires Departrnent of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the IiabiliTy insurance coverage normally required by law.But
signature below,I hereby waive this requirement.I arn the(check one) ❑ owner ❑bwner s agent. � �
Owner/Ageot -
Signature , Telephone No. PERMIT FEE:$50.00
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