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HomeMy WebLinkAboutElectrical PermitAPPLICATION FOR -PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN OF YAR 0� (OFFICE USE ONLY) $a5.od MIT NO. E—V (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. / Augcation (Street & Number) —a— -,i �/ �1` Owner or Tenant I/ 11, ! 1*/_ g ^ & 1, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service New Service Amps / Volts Amps / Volts Number of Feeders and Ampacity. Location and Nature of Proposed electrical Work: Yes No (Check Appropriate Box) Q Utility Authorization No. D L r/ ✓ Overhead Undgrd N ff Mette s � 2D � �, Overhead � Undgrd � N .�fMeters�� fil Completion oftbefollowing table maybe waived b the Inspector of Win ttach additional tail if desired, or as required by the Inspector of Wires INSURANCE COVERAGE: Unless waived by the owner, no permit for B may issue unless the licensee provides proof of liabiliti `—insurance including "completed operation" coverage or its substantial equivalent. The u dersigned cent ies that such coverage is in force, and has exhibited proo of same to the permit issuing office. CHECK ONE: INSURANCE [� BOND 71 OTHER (Specify:)&_4C(J� (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO. Licensee: Signature LIC. NO. (If applicabl enter "exem i he�ce sen number line.) Bus. Tel. No.: Address:_ , oX q � `t !l A� Alt. Tel. No.: OWNER'S WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I and the (check one) owner owner's agent. Owner/Agent Signature Telephone No. No. of Total No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA Above In- No. of Emergency Lighting No. of Lighting Fixtures SwimmingPool rnd. rnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices Total No. of Ranges No. of Air Cond. Tons No. of Alerting Devices Heat Pump Tons KW No. of Self -Contained No. of Waste Disposers Totals: _Number Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers Heating Appliances ecuuty Systems: o. of Devices or Equipvalent No. of Water No. of N a Wiring: Heaters KW Signs B t o. of Devices or Equivalent communications Wiring: No. Hydromassage Bathtubs No. of Motors To P No. of Devices or Equivalent ttach additional tail if desired, or as required by the Inspector of Wires INSURANCE COVERAGE: Unless waived by the owner, no permit for B may issue unless the licensee provides proof of liabiliti `—insurance including "completed operation" coverage or its substantial equivalent. The u dersigned cent ies that such coverage is in force, and has exhibited proo of same to the permit issuing office. CHECK ONE: INSURANCE [� BOND 71 OTHER (Specify:)&_4C(J� (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO. Licensee: Signature LIC. NO. (If applicabl enter "exem i he�ce sen number line.) Bus. Tel. No.: Address:_ , oX q � `t !l A� Alt. Tel. No.: OWNER'S WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I and the (check one) owner owner's agent. Owner/Agent Signature Telephone No.