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• I) _LJaporiaaawf 7 &mica No. —03
ctgss.ey end Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [ReOev. I/07j flews
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed is aeead.ct wilts de Atus.demete Eleciiai Cade(MEC).527 OAR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Data 7/27/2020 '
City or Town oft Yarmouh To the bupactor of Wires:
By this applieamoa the undersigned gives notice onis at ber intention to pnibrm the electrical work described below.
Laced°.(Street A Number) 18 Hialeah Lane
Owner or Tense. Jeanne Brown T.lepheus No.508 398 3274
Owner's Address
Is tide penult I.a jenedoo with a bedew permit? Yes CI N. ❑ (Cheek Appropriate See)
Purpose of Building Home Utility Authsetred's Ns
[dads%Service 100 Amps 120/240 Volts Overhead x❑ Uaigrd❑ No.of Meters 1
New Sends Amps / Volta Overland❑ Usdg i❑ Ns of Melon
Number of Feeders sod Ampeely
Localise sad Noire of Proposed Electrical Work: Basement 1/2 bath wiring
Cosmistbe vide p bwotatalb any be waiver by the/tinsels of Wbve
Na of Recessed Luslsslns Ns of Ce4Sespr(?iddls)Pass rte.sirTotal
Treedbr ears KVA
Ns of Leel.aM Outlets Net.of Hut Tube Ceserslees KVA
Ns of Unaware Swlmalsgleel Above 0 ts. 0 se sr unituserra racy ugarueg
E Ns of Receptacle Oudsts Ns of OE Peones rill*ALAaMI• IN*.el Zees"
UNs of Switches N...<Gm/users K teaveris
cps
E Ns of Raises Ns of Ale Coed. Teo Na of Abodes Doke"
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Ns of Waste Disposers iteelT1=1Peadier[lies. (KW •Nw ef• • es'
C .TEA_
@ Ns of Dbhweshe s Spew true lfsatw KW Lsesl p CI Mar
Dryers Appliance" Kw s e
N co
Ys ofofHsavetsrs KW Nw.r A 1'..s DatatsWleb� err[q.lvslsut
E Sus st w E
Nw Hydrometric/gE safbhbe Ns of Meters Total N! t Nei of Deo�te"s or
R sRisl
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.ls h olitNnel dated Vdrb.d er err rule rJby the huh ,er of Wires:
Estimated Value of Electrical Work: (When required by muaieipe policy.)
Work to Start 7/26/2020 Impad ns to be requested is acconbsce with MEC Rule lo,and upon completiow.
‘‘ INSURANCE COVERAGE: Unless waived by the owner•no permit tar the peribrmeaee of electrical work may issue unless
t/� the licensee provides proof of liability inn macs inchadinecompletsd opendost'covers.or its substantial equivslams. The
(�/j� undersigned certifies that suck coverage is is(once,ad hes exhibited proof of same to the permit issuing office.
CHECK ON& INSURANCE ® BOND 0 OTHER ❑ (SpeeifT)
Q
A I cerrl/jA rein the po es end pe okke of porJsey,that the le/Iiremebs eve Mk eppifrstbw is tree and aver/era
FIRMMOM: Emerson Electrical Construction Inc. LIC.NW A20136
J Licenses Euaene Emerson SIgnal.ne LIC.NO.: 55 513A
1-1 (I/ overopp koble a "otemy M lea the&ow eer.nee) gas Tel mum 55 8
Address p a Box 1122 Orleans. Ma. 02653 Alt Tel.:far 3An 1113
'Per M.O.L.c. 147,s.37-61,security work requites Departments of Public Safety"S"Lica= Lie.No.
Z OWNER'S INSURANCE WAIVER: I am aware that the Licensee dais net have the liability Insurance coversp normally
required by taw. 8y my sitptsmm below,I hereby waive this requirement. I am the(check one)Q owner ❑owner's agent.
Owner/Asset
Slgsston Telephone No. I PERMIT FEE:S 75.00
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