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On y, Permit No. 919 t 14
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1/07] (leave blank)
1` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed hi accordance with the Massachusetts Electrical Code(MEg,527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g^ r - 0
V 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 b�
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Location(Street&Number)n / s/�/i c54/ fi(J/ •. ";�f� .."r.`
Owner or Tenant /'C!7Q a-#2 T <T!"ee i elepho a �"
s-
l 1 Owner's AddressG
Is this permit in conjunction '' a building Yes 0 No (Check - , ,,pp C ' 2O /
j' Purpose of Building J/ t/ 1 .) Utility Authorization No. ANG/ 9
1 Existing Service D Amps f C/ �jt*oits Overhead 0 Undgrd�No.of Meters
-..„,1 New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
11, Number of Feeders and Ampacity q
' Location and Nature of Proposed Electrical Work: A)/ise., 'J T 'TO 3
.a
I ii
tr ,. ,
vs Coa�letion oflhe .,�•�i�1 r ! ;°r oJT�ues.
Ili No.of Recessed Luminaires No.of Ceil.�.(Paddle)Fans T ' ', ""al
CaNo.of Luminaire Outlets No.of Hot Tubs o A
No.of Luminaires Swimming Pooland. 0 ,7. -
Above and. II ,4i'4,41-171: 4
No.of Receptade Outlets No.of Oil Burners FIRE • ' ; I
No.of Switches No.of Gas Burners.7;2Aro.of ,Initialing 1 �
Tot
1.:-E No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers __Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/ADevices
No.of Dishwashers Space/Area Heating KW Local 0 MC Qection 0 Other
No.of Dryers Heating Appliances KW Sec°rfty oSj�- es or Equivalent
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or ' ,uivalest
No.Hydromassage Bathtubs No.of Motors Total HP T elecomm. Devices or Ea -,
OTHER:
Attach additional detail rj'elesired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ` '14, (When required by municipal policy.)
Work to Start till I Cad Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless • •-. .y the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability',, :_1•" including"completed operation"coverage or its substantial equivalent The
undersigned certifies that such cov-. is in force,and has exhibited proof of same to the permit issuing office.
�` CHECK ONE: INSURANCE It BOND 0 OTHER 0 (Specify-.) Cy
\� I cerilfy,under the�mid of perjury,that the informatio on this application is true and complete. /2 q y`/
FIRM NAME: /v e/ 1 SC/tf Q—t" e r '� CLIC.NO.: 7
Licensee: Signature ��� ,(�/ ��i�/l/ LIC.NO.:
pfaPpress•licobte. he�i�m�a1�����fv
� �c' Burs.Alt TeL Na.. Q 0 -2 X /?s-2
Add � A l
*Per M.G.L..c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
C: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
i required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent
f Signature Telephone No. PERMIT FEE:$