HomeMy WebLinkAboutElectrical Permit � �_ _ ___ -�_
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�{ Sf i� � 4 ?0�j Perrnit No. BLDE-18-001241
ssachusetts
_ $OAI�'L3�`F7��'I PREVENTION REGULATIONS Occupancy and Fee Checked
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
, AII work ro be performed in acwrdance wiN[he Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT INlNKOR TYPEALL lNFORMATlON) De[¢:9/3/2015
City or Town of: YARMOUTH To the Inspectoro,('wires:
� By[his application Ihe undersigned gives no�ce o �s or er m en on pe orm e e ec �ca work described below, L��
Locafion(Street&Number) 124 PAWKANNAWKUT DR �j / ���j
Owner or Tenant PRIOR GEORGE T Telephone No.
Owner's Address PRIOR JOAN M, 124 PAWKANNAWKUT DRIVE, SOUTH YARMOUTH, MA 02664
Is this permit in conjunc6on with a building permit? Yes ❑ No ❑ (Check Approprie
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.ofM
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Mettrs
Number otFeeders and Ampacity
LocaHon and Nature of Proposed Electrical Work: wiring for septic pump and alartn
Completion ojthe following mble may be waived by the Inspector ojWires.
No.of Recessed Lumioaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transf rmers KVA
No.of Luminaire Outlets No.otHot Tubs Generators KVA
No.of Luminaires Swimming Pool ��a° ❑ Imd ❑ No.of Emergency Lighting
Bett nits
No.of Receptacle Outlets No.of Oil Bumers F'IRE ALARMS No.of Zones
No.of Switches No.of Gss Burners No.of Detection and
In'f tin Devic
No.of Ranges No.of Air Cond. ,T�.��S� No.of Alertieg Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �
Totals: Detecti Alertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Muoicipal p Other:
Conn ction
No.of Dryers Heating Appliances KW Security S�shms:'
No. v�ces u' elen
No.of Water Kµ, No.of No.of Data Wiring:
Re i ns allas No.o Devic s o uival
No.Hydromassage Bathtubs No.af Motors 1 Total HP Telecommunications W1dng:
No. f D ices r E ivalen
OTHER:
Aimch additronal demil rf desired,or as required by the Inspecror of Wires.
Fstimated Value of Etectrical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 1Q and upon completion.
INSURANCE COVERAGE:Unless waived by the owneq no permit for the perfortnance of electrical work may issue unless the]icensee
provides proof of(iabiliTy insurance including"wmpleted operation"coverage or its substantial equivalent.The undersigned certifies that such
coverage is in force,and has e�ibited proof of same to the perniit issuing office.
CHECKONE:INSU2ANCE ❑ BOND ❑ OTHER ❑ (SpecifyJ �
I cer[ijy,under the pains and pena[ties oJpery'ury,that the information on[dis app[ication is true and complete
FIRM NAME: DAVID W SILVA
Licensee: DAVIDWSILVA Signature LIC.NO.: 20608
(Ifappltcpble,enter exempP'rn[he license numberline.) Bus.Tel.No.:
Address:55 THISTLE DR, CENTERVILLE MA 02632 Alt.Tel.No.:
•Per M.G.L.c. i47,s.57-61,securiry work requires Deparlment of Public Safery"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 am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signamre Telephone No. PERMIT FEE:$50.00
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