HomeMy WebLinkAboutElectrical Permit „�'`�, Commonwealth of off��a�use on�y
� � Massachusetts PermitNo. BLDE-16-005695
'°"'e' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.l/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:4/20/2016
Clty Ol'TOWII Of' YARMOUTH To the Inspector of Wires: �
By this application the undersigned gives nohce o is or er mtenhon to pe orm t e e ectnca work described below.
Location(Street&Number) 27 HARDING LN
Owner or Tenant WOODS MARIANNE Telephone No.
Owner's Address 27 HARDING LANE,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Sox)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work. .
,� �.��
Completion of tlze following table nzay be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above � In- � No.of Emergency Lighting
rnd. rnd. Batterv Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Inrtiatin Dev�ces
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers eat Pump Number Tons KW No.of Self-Contained �
als: Detection/Alertin Devices
No.of Dishwashers rea Heating KW Local ❑ Municipal p Other:
Connection
No.of Dryers eating Appliances KW Security Systems:*
No.of Devices or E uivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Si ns Ballasts No.of Devices or E uivalent
No.I3ydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wir•es.
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 comp etion���v���J���
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue u ess thMe,�li�c/ensee �n
provides proof of liability insurance including"completed operation”coverage or its substantial equivalent.The undersig d cey[�tHBt�u�t�J�6
coverage is in force,and has e�:hibited proof of same to the permit issuing office.
CHECK oNE:1NSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) HEALTH DEPT.
I certify,under tlie pains and penalties of perjury,t&at tlte information on this applicatioi2 is true a►atl complete.
FIRM NAME: THOMAS S KIMBALL
Licensee: THOMAS S KIMBALL Signature LIC.NO.: 31130
(Ifapplrcable,enter"exempP'in tke Izcense number/ine.) Bus.TeL No.:
Address:224 DEXTER LN, ROCHESTER MA 02770 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department 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.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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