HomeMy WebLinkAboutElectrical PermitCommonwealth of Massachusetts Official Use Only
Department of Fire Services j Permit No.
BOARD OF FIRE PREVENTION REGULATIONS R
Occupancy and Fee Checked
Wev. 111991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (WC)7 527 CMR 12.00
Date: 11/05/2002
City or Town of Yarmouth To the InsP ec e
�
B� this application the undersigned gives notice of his or her intention to perform the electrical .vwegk described'(b
Location (Street & Number). 31 Paannee Dr. j
Owner or Tenant Margaret Rafferty I :7 002
Owner's Address. same tto i
Is this permit in conjunction with a building permit? Yes No X (l~Y
Purpose of Building 1 family Dwelling Utility Authorizadon No.
El istWg Service Amps Volts Overhead Un d
dgr n No. of ?Meters
New Service Amps Volts Overhead URdgrd No. of M.ewr4
Number of Feeders and _Ampacity
Location and Nature of Proposed Electrical Work: Wire septic system puntp station
of Recessed FhWres
Of Lighting Outlets
of Lighting Futures
No. of Receptacle Outlets
of Switches
of Manges
of Waste Disposers
of Dishwashers
of Dryers
Heaters KW
No. hydromassage Bathtubs
OTHER:
of Ceii.-Susp. (Paddle) Fans
Of Hot Tubs
mmingPool Above Ia-
Zru& Q �El
of Oil Burners
of Gas Burners
of Aix- Coni. Total
Area Heating KW
g Appliances KW
zfl_fl
Ms Ballasts
Of Motors Total HP
table may be Naived
K'VA
KYA
rres.
IFIRE ALARMS }No. of Zones 3
of Alerting Devices
El tither
No. of De -vices or Egnivalent I
Telecommunications Wiring:
No. of Devices or Ennivalent !
INSURANCE COVERAGE: Unless waived by the
Attach additional detail if desired or as req-ied by the Inspector of Tf'ires.
owner, no permit for the
the licensee provides performance of electrical work may issue unless
p proof of liability insurance in:,luding `-completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is m force. and has exhibited proof of same to the permit issuing office.
CHECK ONE. RgsLgtANCE x
BOND ❑ OTHER E] (Specify_) Safety- Insurance
10-01-2003
Estimated Value of Electrical Work(ER- ration Date;
(When required by municipal policy.)
Work to Start: 11105/2002 inspections to be requested in accordance with NEC Rule 10. and upon completion.
t cerci_ }% under the pains and penalties ofperjury, that the information on this application is true and complete -
FIRM NAME: Re-CommElectric Inc. LIC. NO.: A9581
Licensee: Robert Piquette_
Signature -� j LIC. NO.: E17712
(1, f appticabl� enter exempl " in the license number line.)- "--'- � � � '
Address: 211, Fruean way SouthYarmouth Mass. 02664 Bus. Tel. No.: 508-398-5407
OWNER'S INSUWAIVER.RANCE AiVER: 'Iam aware that the Licensee does not have the liabili `ink Tei. No.:
required. by law. - ty insurance coverage normally
B3' my signaturebelow, I hereby varve this requirement. i am the (check one)Elowner ❑ owners agent.