HomeMy WebLinkAboutBLDE-21-000945 Commonwsa&o�//laaaachuaslta Official Use Only
'� 't c� c� {� Permit No.(-- --( -- 0 ��
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1 r Occupancy and Fee Checked
- BOARD OF FIRE PREVENTION REGULATIONS [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: 0 8/8.10
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 described below.
Location(Street&Number) /I art6 i! WA `j
Owner or Tenant 6 A SU J Pre M 0 v ILA Tel• . .one No. STY 3(4 0 41237
Owner's Address
( Is this permit in conjunction with a building permit? Yes ❑ No ❑ ���` c A
IN
Purpose of Building Utility Autttoricn
Existing Service Amps / Volts Overhead❑ Undgrd' o,� �
, ../
New Service Amps / Volts Overhead❑ Undgrd❑ No.o > •• '4i
Number of Feeders and Ampadty
1..
.): Location and Nature of Proposed Electrical Work: of I�i-A-w E X I Sart 1.3(, PANEL RE Pmt ,
„4-„- mc,�'I L,,,,,,-,5 , W 1 R-, KA7 ci-t tJ i'--Cf-t 0 t�L._ ,
Completion of the followinktable may be waived by the Inspector of Wires.
tal
1.L No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fans Traa onVA
No
sformers KVA
f
�'
'Z No.of Luminaire Outlets No.of Hot Tubs Generators KVA
ra
No.of Luminaires Swimmin Pool Above In- No.of Emergency Lighting
ggrnd. ❑ grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners -No.of Detection and -
s Initiating Devices
11! 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/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local 0 Co nnenidection 0
Other
Co
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of WaterKW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage 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: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof 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 0 OTHER 0 (Specify:)
gad I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
�P' FIRM NAME: W IAA N C.)iO Li f-' SA A-R.��r G L. C'Te7.4_C t o A) (/..t L LIC.NO.: Z 4 0 7 S 4
t/�-'•/ V fr Licensee: `nl Li 1.1610 AJ R CoA•te,,- Signature c e)e-J, LIC.NO.: 1 t 37 6 !3
lir/" V'" (If applicable,enter"exempt"in the license number line.) Bus.TeL No.• 506 77 a? 5936
tt� Address: Alt.Tel.No.: 77¢P36 5-en
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
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)0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 76 —