HomeMy WebLinkAboutBlde-21-000771 ( N,4 ?_) C( ,
Commonwsaah.o`Maedachuestte Official Use Only
`Permit No, 2 CP 71
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1(`' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
1/4_4,...
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
•
City or Town of: YARMOUTH ` To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work d scribed below.
Location(Street&Number) 31 IA 1(,hLIN/q J ST Lt It. )(ArRo v C b 7
Owner or Tenant j? . (h..J ill p fl PS Telephone No.1 9q y 249
Owner's Address 3c.) ii i(rh1 ri ost N 7 ti).4v s f y4 r Al v t)7'' 62 6 73
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Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appro tAittil B >'
Purpose of Building f-Mi-i/'= Utility Authorization No.
Existing Service 2 ZO Amps / Volts Overhead 0 Undgrd 0 iiifi.p?' i etet 4y_�
,
New Service Amps 1 Volts Overhead 0 Undgrd❑ et b
• Number of Feeders and Ampacity 8t?
Location and Nature of Proposed Electrical Work: ltiu, is%0
l4
aa.
Completion of the following table may be waived by the Inspector of lyres.
till No.of Recessed Luminaires e j No.of Ceil.-S (Paddle)Fans No.of Total
u�• Transformers KVA
V. I
nNo.of Luminaire Outlets /2.-. No.of Hot Tubs Generators KVA
' No.of Luminaires /L/ Swimming pool Abov grnd. Bae 0 In- 0 No.ofttery U emniertsgency Lighting
Able
No.of Receptacle Outlets n No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
•Z Initiating Devices
1 Li No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: -"'" ""`���' Detection/Alertin Devices
No.of Dishwashers 1 Space/Area Heating KW Local❑ Monnunie ectionge ❑ Other
C
No.of Dryers r Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromaasage Bathtubs No.of Motors Total HP . Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 4 (2,060 (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion.
cl2kINSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
„, ty the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
it�?3 Za undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
- FIRM NAME: LIC.NO.:
Licensee: Signature LIC.NO.:
A c?-- (If applicable,enter"exempt"in the license number line.) Bus.TeL No.:
Address: Alt.TeL No.:
Vx *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
t 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 am the(check one)[Jjrowner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 1 S