HomeMy WebLinkAboutElectrical PermitAPPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WOR►
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
TOWN OF YARMOUTH
(OFFICE USE ONLY)
By
Fee: $30 16 65 G
PERMIT NO.`��— 015 3� Q
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /0 I r i I e 4j
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below. r
Location (Street & Number) G a. , , v'� 5 ,"c JCS
Owner or Tenant y ,t M
Owner's Address III
r -1w.- \LU
Telephone No.
Is this permit in conjunction with a building permit? 0 Yes J!;No (Check Appropriate Box)
Purpose of Building f�f ei Utility Authorization No.
Existing Service Amps it Z24' Volts Overhead;F Undgrd 0 No. of Meters /
New Service Amps / Volts Overhead Undgrd 0 No. of Meters
Number of Feeders and Ampacity
and Na�tu7 of Proposed electrical Work: J 2_,%)!2!' ,^')S�
10ii
may be waived by the Inspector
Attach additional detail if desired, or as required e, -M' Pi ctor of Wire
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such covera a is -in
'p force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND OTHERC) (Specify:)
)-Estimated Value of Electrical Work: YS;& . (Expiration Date)
(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 ins and penalties of perjury, that the information qn this application is true and complete.
FIRM NAME: •re- s'<Tc- LIC. NO. _S
Licensee:/I.e 7� Signature _, LIC. NO.
(If applicable enter "exempt" in the license number line.) Bus. Tel. No.: �� y - �� s z
_ ddress: u a z -2i%2- , ,,,.. Alt. Tel. No.: Z 2 3 G F Z
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signatu
below, I hereby waive this requirement. I am the (check one) owner owner's agent.
Owner/Agent
Siunstnre TPlenhone 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
In-
�
of Emergency Lighting
No. of Lighting Fixtures
Swimming Pool gmd.Above
rnd.
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
N -57 5T etection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heatm
Totals:
Number ons
— — — —
K
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P g
Local Municipal
Connection Other
No. of D
Dryers
ry
Heating Appliances KW
g PP
Security Systems:
No. of Devices or Equipvalent
No. of Water
No. of No. of
Data Wiring:
Heaters KW
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail if desired, or as required e, -M' Pi ctor of Wire
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such covera a is -in
'p force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND OTHERC) (Specify:)
)-Estimated Value of Electrical Work: YS;& . (Expiration Date)
(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 ins and penalties of perjury, that the information qn this application is true and complete.
FIRM NAME: •re- s'<Tc- LIC. NO. _S
Licensee:/I.e 7� Signature _, LIC. NO.
(If applicable enter "exempt" in the license number line.) Bus. Tel. No.: �� y - �� s z
_ ddress: u a z -2i%2- , ,,,.. Alt. Tel. No.: Z 2 3 G F Z
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signatu
below, I hereby waive this requirement. I am the (check one) owner owner's agent.
Owner/Agent
Siunstnre TPlenhone No