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Home My WebLink AboutElectrical Permit APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 'oFY44,----_ (OFFICE USE ONLY) (Rev.9/05) __ ( — TOWN OF-YARMOUTH . By WITTACNEESE '' j�0 Fee: $ 3 s 0-)mO O no:, PERMIT NO. f I PLEASE PRINT IN INK OR TYPEALL INF RMA ) Date: r °7 'o the Inspector of Wires: By this application tffe undersigned gives notice of his or her intention to perform the electrical vork described below. .ocation (Street&Number ,/, oC-- ' owner or Tenant -----,44--- �� Telephone No./../- 777'---_?.. "7-(-:---W( )wner's Address O �--- '. - , ,,./...?. ;;_.5-- - s this permit in conjunction with a building permit? ❑ Yes ❑No (Check Appropriate Box) ;--) V urpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd Cl No. of Meters New Service Amps I Volts Overhead❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: c'< V 4 • _ ';'.-.>., ,e----1.1111119-1 _,.,,- w Completion of the following table may be waived by the Inspector of Wires • No.of Total No. of Recessed Luminaires No. of Ceil.-Susp.(Paddle) Fans .Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA \-J Above In- 'No. of Emergency Lighting No. of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No. of Receptacle Outlets l% No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices Total \•• Io. of Ranges No. of Air Cond. Tons No. of Alerting Devices Heat Pum Number Tons KW No. of Self-Contained ci. No. of Waste Disposers Totals: p Detection/Alerting Devices Municipal No. of Dishwashers Space/Area Heating KW Local ❑ Connection ❑ Other 'e)? Security Systems:* No. of Dryers Heating Appliances KW No.of Devices or Equivalent No. of Water No. of No. of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent s i No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications of Devices or EWquivalent No.of Devices Equivalent N Attach additional detail if desired, or as required by the Inspector of Wires. N INSURANCE COVERAGE: Unless waived by the owner, no pen,-tit for the performance of electrical work may be issued unless the licensee provides 1, proof of liability insurance includine "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 J BOND CI OTHER (Specify:) (Expiration Date) I ;Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 4-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. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No,: ddress• Alt. Tel. No.: _ 'Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature • hereby waive this re u - mett . I am (eheck one)owner owner's agent.11 Owner/ gent /j 6/ - APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 ,e"+/F Y\ (OFFICE USE ONLY) (Rev.9/05) ` .;'%4 `'_ TOWN OFYA MOUTH By _I. ��eo Fee: 3s 0- PERMIT NO. f 07 (PLEASE PRINT IN INK OR TYPE` LL INF RMA ) Date: . a To the Inspector of Wires: By this application theundersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number ._ �� >c'.. : - h' Owner or Tenant _ Telephone No./- 77f.-.-,-?.-7--‘-----Y((( Owner's Address e7 AL 0,-- I— �r ` - Is this permit in conjunction with a building permit? MI Yes ONo (Check Appropriate Box) O Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead[ Undgrd El No. of Meters iNew Service Amps / Volts Overhead[ Undgrd El No. of Meters sl Number of Feeders and Ampacity il Location and Nature of Proposed electrical Work: c _ 2..P ,� A .Z ,te' .� .✓ V I Completion of the following table may be waived by the Inspector of Wires No. of Total No.of Recessed Luminaires No. of Ceil.-Susp.(Paddle) Fans Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA Above In- 'Generators of Emergency Lighting No. of Luminaires Swimming Pool grnd. Q grnd. B• attery Units No. of Receptacle Outlets t% No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices �� Total '"Sk3j \o. of Ranges No. of Air Cond. Tons No. of Alerting Devices Heat Pum Number Tons KW No. of Self-Contained No.of Waste Disposers Totals: p Detection/Alerting Devices Municipal 4 No. of Dishwashers Space/Area Heating KW Local El Connection El Other Security Systems:* `''" No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water No. of No. of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent 14) Telecommunications Wiring: N. No. Hydromassage Bathtubs No. of Motors Total HP No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. N Ci INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides L� sproof of liability 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 0 BOND 71 OTHER (Specify:) zzs (Expiration Date) ‘. Estimated Value of Electrical Work: (When required by municipal policy.) N Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1-certify, under the pains and penalties of perjury, that the information on this application is true and complete. i FIRM NAME: LIC. NO. f .Licensee: Signature LIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: ' ,ddress: Alt. Tel. No.: C9-e Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I an-i aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature hereby waive this re • met . I am Ceheck one)owner (j owner's agent.il Owner/yent — ,,,,----"--/ �/ r