HomeMy WebLinkAboutE-97-913'The Commonwealth of Massachusetts 0;1b. Cw Gey
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Deportment of Pubiie Sepry
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8OARO OF FIRE PREVENTION REGULATIONS S27 CMR x2:00 1/90 Slea.e
CATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All a orlg to tH performed In accordance .cath the Maesaehusena Electrical Code, S27 CMR two
(PLEASE PFJ= IH nm OR TIPS = IH:ORv.ATION) Date /a -//- 97
City or Tova of .i•/AAntngllli Io the In q argot uk;rF; O
The undersigned applies for a permit to perform the electrical work descri d bet '� ��11
Location (Street 6
0«er or
Owner's
Is chis permit in conj=crion with a building permit: Yes ❑ No [� (Check Appropriate Box)
r,rr Purpose of Building Regrdi,.,'ir,i ke14&-. Utility Authorization NO.
Existing Service Amps / Volcs Overhead ❑ Undgrd ❑ No. of Y<ters
Nev Serrate A=ps / Volt OverLead ❑ Umdgrd ❑ No. of eArers
i
Huber of Feeders and A-paeity
Location and Nature of Proposed Electrical stork q lowye/Ala seew/1, i
No. of Lighting Outlets
No. of Hoc Subs _
No. of I:ansfor_e:s =Deal
r1A
No. of Lighting Fixtures
S+i=Lng Pool grnde ❑ grnd. ❑ I
Generators WA
No. of Receptacle Outlets (Yo.
of OL1 Burners (No.
of _ergercy LL;h[L.ng
9ae-e v Units
No. of Switch Ouclets
90. of Cas Ur Pers
ia.4E ALUMS No. al. Zones
No. of Detection and
Init.at.ag Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ munieipal❑Other
Connection
No. of Ranges
Into. of Air Cond. eons ,
No. of Disposals
Yo. of Hea`�s Iotal Toil
No. of Dishvasherl
Space/Area Heacing 167
No. of Dryers
Heating Devices 167
No. of Stater Heaters 167
Not of oe Oz
Stems Ballasts
Lav Voltage /
Utrinr t/
No. Hydro Massage Iubs
No. of motors Total HP
r-IORM
UNSU?ANCE OOVE =: Pursuant to the requirements of Massachusetts Central Laws
I have a currentLia ilit1► Insurance Policy including Completed Operations Coverage or _tU'substancial
equivalent. YES NO 0 I have submitted valid proof of same to this office. Yr_SIIr NO
If you have checked YES, please indicate the type of
�coverage by checking the appropriate box.
INSURANCE 800,10NO❑ Q=uit❑ (Please Specify)c.]rwWre/-7X- fir%. Oe, oz ' 9
ire[ on ace
Est' --ted Value of Electrical Stork S
work to Start IA -/ a -f'? Inspection Date Requested:
Stgned t`•ter the penalties of perjur;:
FIIL'i NA.`L __ �F/�fLgL__riL�a,2.ars fir_
Ltcensee—�
Address (I o
Rn
Rough Final /�2-/-e-f7
N0. / 3i'7 e --
NO. -
--NO.•
eZc2e) Bus. Tnl. i:o. `O
Alt. Tel. No. .. Wz
0vmzv S IASURANCS vA1VEx: I as aware that the LLeensee doas not have the insurance coverage or 1W suo-
scanclal equivalent as required by Massachusetts Generalws, ane uue my stguture cn'thLs peroie
application valves this requLre:ene.- Owner Agent (Please check one) t
913
WIRE INSPECTOR'S DEPARTMENT
YARMOUTH TOWN HALL
SOUTH YARMOUTH, MASS. 02884
Fee
Date /'�- —/';Z� --9�
a -l' -
Name of Job'6eh�
Name of Electrician Lobes I,IJMA�* %
Location