HomeMy WebLinkAboutElectrical Permit ,. Commonwealth of orr���u�on�y
� F � Massachusetts PermitNo. BLDE-16-002083
� � BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
� v.1/07
APPLICATION FOR PERN"IIT TO PERFORM ELECTRICAL WORK
All work[o be perfortneA in accordance wiN the Massachusetts Electricai Code (MEC),527 CMR 12.00
(PLEASE PRINTlNlNK OR TYPE AGL MFORMATIONJ Dat¢:10/13/2015
C11yO�TOWllOf: YARMOUTH TolhelnspectorofWires:
By this applica[ion the undersigned gives no�ce o �s or er m n on pe ortn e e ce ca work described below.
Locafion(Street&Number) 11 CAPE ISLE DR
Owner or Teoant KOSKI KARL A Telephone No.
Owner's Address KOSKI CLAIRE M, 11 CAPE ISLE DR,SOUTH YARMOUTH, MA 02664-5110
Is thls permit in conjuncHon with a building permit? Yes ❑ No ❑ (Check Appropriste Box)
Purpose of Building Utllity Authorization No. �..
Existing Service Amps Volts Overhead ❑ Undgrd O No.of Meters ',
New Service pmps Volts � Over6ead ❑ Undgrd ❑ No.of Meters �'.
Number of Feeders and Ampacity
Locadon and Nature of Proposed Electrical Work• nd po5t light �
a
Completion oJthe jollawing tab[e may be woived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
sformers
No.of Luminaire Outlets 1 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above � In- � No.of Emergency Lighting
rnd. rnd. B tte Un'
No.of Receptacle OuHe[s No.of Oil Buroers FIRE AI.ARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Imtiatio Devices
No.of Ranges No.of Air Cond. Total No.otAlerting Devices
Tons
No.of Waste Disposers Heat Pump N m r Tons KW No.of Self-Contained
Totals: Detection/Alertin Devices
No.of Dis6washers SpacdArea Heating KW Local ❑ Municipal p Other:
noechon
No.of Dryers Heating Appliances KW Sewdty Sxstems:"
No.oF Dev�ces or E N
No.of Wahr KW No.of No.of Data Wiring: �
Heaters Si ns Ball N .of Devices or ivalent
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunicatioos Widng:
No.o vices or E uiv 1 n �
OTHER:
Anach addiliona!demi!if desired,or os required by(he Inspector af Wires.
Es6meted Value of Elechical Work: (When requ'ved by municipal policy.)
Work to staR: Inspection to be reques[ed in accordance with MEC Rule 10,and upon complerion
INSURANCE COVERAGE:Unless waived by the owner,no permit for the pedoanance of elechical work may issue unless the licensee
provides proof of tiability insurance including"completed opecation"coverage or its substanrial equivalent.The undersi�ed certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INStJRANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I cerlijy,under Jhe pains nnd penaUies ojpery'ury,that the information on this application is true and comp[etc
N[RM NAME: MICHAEL D HOLLISTER
Liceosee: MICHAEL D HOLLISTER Signature LIC.NO.: 10071
(Ifopp(icable,enter"exempY'in the license number line.J Bus.Tel.No.:
Address:85 N DENNIS RD, S YARMOUTH MA 02664 Alt.Tel.No.:
•Per M.G.L,a 147,s.57-61,securiTy work requires Deparhnent of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License,does not have the liability insurance coverage normally required by law.But
signatiue below,I hereby waive this requ'vement.I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Si nature Telephone No. PERMIT FEE:$50.00
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