HomeMy WebLinkAboutElectrical Permit ._—
Commonwealth of Official Use Only
� � a � Massachusetts FertnitNo. BLDE-15-004806
. � BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work W be perfortned in acwrdance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINTlNINKOR TYPEALLlNFORMATION) DaY¢:3/31/2015
City or Town of: YARMOUTH ro rne inspecrorofwr.es:
By this application the undersigned gives mnce o �s or er m ennon pe orm[ e e ec c work descnbed below.
� Location(Street&Number) 56 ROUTE 6A
Owoer or Tenant TEAGUE MATTHEW K - Telephone No.�
, Owner's Address TEAGUE LINDSEY F,56 ROUTE 6A, YARMOUTH PORT, MA 02675
, Is this permit in conjunction with a building permifl Yes ❑ No ❑ (Check Appropriate Box)
� Porpose of Building Utility Authorization No.
. Existine Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampaciry
Location and Nature otProposed Electrical Work: Winng for septic system and replace panel
Completion ojthe follawing mble may be waived by thelnspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.ofLuminaire0utlets . No.ofHotTubs Generators KVA
No.of Luminaires Swimming Pool �nd e � �rnd. � vo.of Emergency Lighting
Batterv Units
No.of Receptacle Outlets No.of Oil Bumers FIRE ALARMS No.of Zooes
No.otSwitches No.of Gas Burners No.of Detectioo and
Initiatin Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons W No.of Self-Contained �
Totals: Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other.
Connection
No.of Dryers � Heating Appliances KW Security Systems:•
N .of Devices or E uivalent
No.of Wahr K�, No.ot No.of Data Wiring:
Heaters Si ns Ballas No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors 1 Total AP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach addiiional detail if desired.or as required by the/nspecmr af Wires.
� Estimated Value ofElectrical Work: (When required by municipal policyJ
Work to start: Inspection to be requested in accordance with MEC Rule 1Q and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the perfocmance of elecVical work may issue unless the licensee
provides proof of liabiliry insurance including"completed operation"coverage or its substantial equivalent.The undersigned ceaifies that such
coverage is in force,and has e�ibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTfiER ❑ (SpecifyJ
!certify,under the pains and penaUies ojperjqry,that the informakon an this app[ication rs bue and complete
FIRM NAME: DAVID W RAUNELA
Licensee: DAVID W RAUNELA Signature WC.NO.: 30394
(UaPP/icable.entes"uempP'in the/icense rtvmber[ine.) Bus.Tel.No.:
Address:35 CROWN GRANT DR, DENNIS MA 02638 Alt.Tel.No.:
'Per M.G.L.c. 147,s.57-61,securiry work requires Departrnent of Public Safery"S"License:
OWNER'S INSURANCE WAIVER:I am awace that the License does not hcrve the IiabiliTy insurance coverage norma(ly required by law.But
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent.
Owoer/Ageot
Signature Telephone No. PERM7T FEE:$50.00
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