HomeMy WebLinkAboutElectrical Permit •
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' I� ' Permit No.
,,� ` �,�! �� �cuarttnrttt of public 'nfctu i
ii ; 0..,•:,.:-4,.--2 Occupancy b Fee Checked....i
:, BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12.00 5/92 (leave blank)
Jtl
meA PLICATION FOR PERMIT TO PERFORM ELECTRICAL
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12.00�O
(PLEASE PAINT IN INK OR TYPE ALL. INFORMATION)
w City or Town of /7 — -
140. �1 Date
` p' The udersi ned appliesp° -- •rot Wire
9 for a permit to perform the electrical work des •ed •T':'+•
Location 'tJ
(Street & Number) -� u ,
An
• t� w Owner or Tenant Cullen ii- JUL �� V
Ca A
Owner's Address 1. Yarmouth MA.
Is this permit in conjunction witt1 a building permit: Yes 0 No 7
Purpose of Building Dsltel_1 i na �, r (Check Appropriate Boa)
Utility Authorization.No.
Existing Service Amps / Volts ..._2...`,F.
.�
,.� Overhehd 0 Undgind 0 No. of Meters
_ W New S_ eke Amps f Volts
Overhead 0 Undgrnd 01 ' No. of Meters . 01
Gw W Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work E1Qct. to dewatering pump & tank alarm
I-+ H
ter,
it
t..i G 'S
No.of lighting Outlets '
No. of Hot Tubs .��
No.of Itanatormors INA • `R
hl
•
No.of Lighting Fixtures
Swimming Pool Above In•
gmd. ❑ gmd, ❑ a3eneratots INA
1
No.of Receptacle Outlets No. No.of Emergency Lightingng
of Oil Burners
. Battery Units •
No.of Switches No. of Gas Burners
•
f,r t..7 FIRE ALARMS `
r.4 t� No.of Zones
►•+ r.1 No. of Ranges
iC No. of/ nd
cc
—7711.
et y No. of Disposals p,c7( / I
•
•
No.ot PtJ,JiJs
evkes
No. of Olshwashers 7-- // ed
Spaca/A �� %1 ' ���y-�J 11 17.71
ri- No.of Dryers • Heatingv v f p Oevips.
pal
7 No.of Water Heaters W* , -.
No.of
lection ❑� '
If
, KW Signs7 c, ' / W i
Hydro Massage Tubs
D_ f OTHER: No. of M f) �� SZ a11
zi i as INSURANCE COVE
I have RAGE: Pursuant to the rnquirema
i,,Ia current Liability Insurance Policy irac!uding t
;: C� have submitted valid proof of same to the Once- YE; "7 ) ----? �J
checking the L �►alent. YES ! NO
y INSURANCE appropriate box. late the type of cpvere t
t BOND O OTHER G (Please
"' cz�Cx APPttop _ 12/31/98 MI
1tIAg BOX: I have Worker's G (Exp iratlon Oa
NEstimated Value of Electrical Works 400.00 _�• �' I have no Employee., t7
Work to star.2f27/98
i ^ Signed under the,Penalties of perjury; t�Pection Date Requested;
1 t �, i+iwflh Final 7/27/98
FlRM NAME Hinckle and Son
License. J. Hinckley A7795
j, Signature i �►� UC. NO.
Iii �dt°aa � � 651 Centerville, lip, eyeuc. No.
: kOWNER'S INSURANCE WAIVER: t am aware that the ;'• No.421 R h R ri •e
t . q WN b licensee does not have the insura Ali. ei. No.Y Massachusetts General taws, and that insurance coverage Gins substantial
(Please cheek One)
my signature on this equivalent as ie
permit a�rlication waives this requirement, Owner
Agent
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