HomeMy WebLinkAboutElectrical Permit � .
. � Commonwealth of Official Use Only
� Permit No. BI.DE-16-00281 �--°—�'-'-`�"�"'-�-"-�"'"�"+
Massachusetts — �
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• �"" BOARD OF FIRE PREVENTION REGL7LATIONS Occupancy and Fee Checked
, , Rev.1/0
APPLICATION FOR PER1t�IIT TO PERFORM ELECTRI �;:�?�(��►��-� .
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 2.OD ` � �
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:11/12/2015
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives no.,ce o �s or er m n on o pe orm e e ec c work described below.
Location(Street&Number) 46 SIERRA WAY
Owner or Tenant BRUYERE MARC D Telephone No.
Owner's Address BRUYERE KRISTEN R,46 SIERRA WAY,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Apprnpriate B
Purpose of Building Utility Authorization No.
Eaisting Service Amps Volts Overhead ❑ Undgrd O No.of Meters
New Service Amps Volts Over6ead O Undgrd O No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: SeptiC pump 8nd alarm
Completion of the following table may be waived by the Irtspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Tr sform rs ,
No.of Luminaire Outlets No.of Hot Tubs Generators KVA '!
No.of Luminaires Swimming Pool Above � In- � No.of Emergency Lighting
rnd. rnd. g i
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones '
No,of Switches No.of Gas Burners No.of Detection sud
I �ti tin D v�ces
No.of Ranges No.of Air Cond. TO�$� No.of Alerting Devices
No.of Waste Disposers Aeat Pump Number Tons KW No.of Self-Contained �
Totals: Dete i n/Alertin Device
No.of Dishwashers SpacelArea Heating KW Local ❑ Municipal p Ot6er:
Connection
No.of Dryers Heating Appliances gW Security Systems:*
No of D �ce's r E ivale t
No.of Water �, No.of No.of Data Wiring:
eater Si s Ballasts No.of v' or E uivalent
No.Hydromassage Bathtubs No.of Motors 1 Total FIP Ne�lecollmmunicallons W'ia ng: '
OTHER: I
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Attach additional detail{f desire�or as required by the Inspector of Wires. �
� Estimated Value of Electrical Work: (When required by municipal policy.) �
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion. �
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee I
• provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned cert�es that such �
coverage is in force,and has exhibited proof of same to the permit issuing of�ice.
CHECK ONE:INSURANCE ❑ BOND O OTHER ❑ (Specify:) f
I certify,under thepains andpenalties ofperjury,that the informalion on this application is true and complet� `
FIRM NAME: STEVEN J PAINE !
Licensee: STEVEN J PAINE Signature LIC.NO.: 12743 G
(Ifapplicable,enter exempt"in the license number line.) Bus.Tel.No.• �
Address:108 CONSTANCE AVE,W YARMOUTH MA 02673 Alt.Tel.No.:• �
'Per M.G.L.c. 147,s.57-61,secunty 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 �
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent. �
OwnedAgent
Signature Telephone No. PERMIT FEE:$50.00 �
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