HomeMy WebLinkAboutElectrical Permit APPLICATIONTOP` MOT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
of Yq.
3? q (OFFICE USE ONLY)
TOWN OF YARMOUTHBy
" EESE Fee: $ •00
3i l PERMIT NO. 6- OP' w YO
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: `".3/-6
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work
described below. .//
Location(Street&Number) IIP 4-1/ 5,' '��`xo Tb' 'd.2. T
Owner or Tenant 1'/`n/¢A/C>(S fid/a R--II-e-1--C— Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? 0 Yes 1 No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead El Undgrd El No of Meters
New Service Amps I Volts Overhead El Undgrd El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: b./ ../._e D cs(toot TIL r�c Gr%o!+/ Pam, yii =
Completion of the following table may be waived by the Inspector of Wires
No.of Total
No. of Recessed Fixtures No. of Ceil.-Susp.(Paddle)Fans Transformers KVA
` No. of Lighting Outlets No. of Hot Tubs Generators KVA
Above ri In- en No.of Emergency Lighting
No. of Lighting Fixtures Swimming Pool grnd. grnd. Battery Units
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No. of Switches No. of Gas Burners Initiating Devices
Total
No. of Ranges No. of Air Cond. Tons , No. of Alerting Devices
A Heat Pump Number Tons KW No.of Self-Contained
1 No. of Waste Disposers Totals: I - Detection/Alerting Devices
Municipal
No. of Dishwashers Space/Area Heating KW Local El Connection El Other
Secutity Systems:
,ti
No. of Dryers HeatingAppliances KW No.of Devices or i 1 -�'
No.of Water No.of PP No.of Data Wiring. L .. IJ ,If S
. Heaters KW Signs Ballasts No.of Devices or ivalent
,J., Telecommunications ' ing;
-i::14 No. Hydromassage Bathtubs No. of Motors Total HP Z No.of Devices o ivaWj, 1 7 f)f)1
J
Attach additional detail if desired,o yrequired le Inspector of Wres.
, NSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless he Ih.�«m.e t, ..1—,...—f of hcb+ity
insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and has exhibited proof
of same to the permit issuing office.
CHECK ONE: INSURANCE BOND OTHER (Specify:) 0/(-) / L-
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy)
Work to Start: 1 3/-0 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
(A..
FIRM NAM . t LIC.NO.
Licensee: �,�/�- Signature ti LIC.NO. 30043'3
(If applicable enter"exempt" in license n bet line.) Bus.Tel.No.:
Address: c q-a/v L _ B ( Lw c re, _ Alt.Tel.No.: 9Y( 'I 2..-a
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law.By my signature
below,I hereby waive this requirement.I and the(check one) owner 0 owner's agent.Q
Owner/Agent
Signature Telephone No.