HomeMy WebLinkAboutBLDE-22-000903 RECEIVED
s �I 1L AUG1t201
o .4, a[th of Maeaachuea(fa Official Use Only
'J IL ue-ARENT-" 17 i� Permit No.
E-22--09 0J.• is,ar ni e nip.SPIIkedy
f! Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
(leave blank)
4S 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: F —/7 —.3-1
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.
J Location(Street&Number) C,j WI h r s-d{.-f
S, Owner or Tenant p� (0(ate 1 t,` Telephone No.rot &c-F y!®..2.
•�l Owner's Address 3 3 TILS t�-t- 1--414-4-- �'* ( O tn, d, ri
J� Is this permit in conjunction with a building permit? Yes No
d� � ❑ (Check Appropriate Box)
.. Purpose of Building (2.o s l �-t .J.. Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd L2 No.of Meters /
Ue New Service
.Ivt9 Amps i.1-1/41 l?NO Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
CLocation and Nature of Proposed Electrical Work: 1,4,e,...„, ite,t4,k
vi
Completion of the followinktable nuy be waived by the Ins ector of Wires.
G4s No.of Recessed Luminaires (7 No.of Cell.-Soap.(Paddle)Fans No.of Total
p! Transformers KVA
'Zt No.of Luminaire Outlets 6 No.of Hot Tubs Generators KVA
No.of Luminaires i t. Swimming Pool Above ❑ In- No.of Emergency Lighting
grnd. Rrnd. ❑ Battery Units
No.of Receptacle Outlets i J No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners 'No.of Detection and I
i t+ Initiating Devices
No.of Ranges No.of Air Coad. Vital
a, Tons y No.of Alerting Devices
No.of Waste Disposers Heat Pump 1 Number Tons JXW No.of Self-Contained
Totals: Detection/Alertin Devices
No.of Dishwashers ] Space/Area Heating KW Local 0 Municipal
Connection 0
Other
No.of Dryers I Heating Appliances KW Security Systems:*
No.of Water No.of No.of No.of Devices or Equivalent
Heaters KW Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER:
No.of Devices or Equivalent
Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ,V-S 000
(When required by municipal policy.)
Work to Stan: ( — 17 --„, 5„ 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 ® BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties o perjury,that the information on this application is true and complete.
FIRM NAME: 1M 1la1 (�
Licensee: 1 �1 GAA-4-
LIC.NO.: 3?60
S lout Signature - LIC.NO.:
(If applicable,enter"exempt"in le license n�?ber line.) r
Address: I I kle 1A A- S.44 14.cs 1 v l C. l ki IN25-6.) Bus.Tel.No.: 3•
*Per M.G.L.c. 147,s.5?-61,security work requires Department of Public Safety"S"License: Alt.Lic.Tel•No. 3 V_63-
ds
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 owner owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$