HomeMy WebLinkAboutElectrical Permit6 1' a Commonwealth of OfficialUseOnly
��� Massachusetts PermitNo. BLDE-16-002162
�"' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/09
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts ElecVical Code (MEC),527 CMR]2.00
(PL6ASE PRlNT IN INKOR TYPE AGL INFORMAT/ONJ Dat¢:10/14/2015
Cityo�ToWllof: YARMOUTH Tothe/nspectorofWires:
By this applica[ion the undersigned gives no�ce o �s or er m en ion o pe orm e e ec ca work described below.
Location(Street&Number) 43 MEADOWBROOK RD
Owner or Tenant OBOYLE WILLIAM A Telephone No.
Owner's Address OBOYLE MARIANNE, 43 MEADOWBROOK RD,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose otBuilding Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service pmps Volts Overhead ❑ Undgrd ❑ No.ofMeters
Number of Feeders and Ampacity
Location and Nature of Proposed ElecMical Work: Septic system and alarm
Completion of the following table inay be waived by!he lnspector ojWires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
T anst me s KVA
No.otLuminaire Outle[s No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool ��a e ❑ I`nd ❑ No.of Emergency Lighting
Batter Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zooes
No.of Switches No.of Gas Burners No.of Detecfion and
Initia in D vic s
No.otRanges No.of Air Cond. Total No.of Alertin Devices
' T ns g
. No.of Waste Disposero Heat Pump Number Tons KW No.of Self-Contained
Totals: DetectionlAlertin Devices �
, No.of Dishwashers Space/Area Heatlng KW Local ❑ Municipal p Other.
Connection
No.of Dryers Heating Appliances KW Security Systems:•
� No.of Water No.oCDevices or E uivalent
Heaters KW No.of No.of Da[a W irin
Si ns Ballasts No. fD vicesorE uivalent
No.Hydromassage Bathtubs No.otMotors 1 Total HP Telecommunica[ions Wiring:
OTHER:
No. fDe ice orE uivalent
Attach ndditiona!detail ifdesired,or os required bylhe Inspector of Wires.
Estimated Value of Elechical 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 Por the performance of electrical work may issue unless the licensee
provides proof of liabiliry insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such
coverege is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTHER ❑
I cerkjy,underlhe pains and pena(ties o er'u Uiat Nie injormation on ikis�lication is true and camplete,
/P J rl',
FIRM NAME: DAVID W SILVA
Licensee: DAVID W SILVA 5ignature
(Ijapplicable,enrer exempY'm[he lrcense number Iine.J LIC.NO.: 20608
Address:55 THISTLE DR, CENTERVILLE MA 02632 Bus.Tel.No.:
'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safery"S"License: A�t Tel.No.:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liabiliry insurance coverage normally required by law.Bu[
signature below,I hereby waive this requirement.I am[he(check one) ❑ owner ❑ owner's agent.
Owner/Agent �
Signature Telephone No.
PERMIT FEE:$50.00
_ • Gs _�'`D
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�~- OCT � 6 2015
HEALTH DEPT.