HomeMy WebLinkAboutBLDE-23-000523 (2) ce....ontvoaRh 4 Mamaclusislle Official Use Only
r,, ,/ 2eparim nt o/`7:a Jervkai Permit No. ��j--��Z3
BOARD OF FIRE PREVENTION REGULATIONS Occupancy peC�' d
Rev. 1/07J (leave blank)k)
' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
1 All work to be performed in accordance with the Massachusetts Electrical Code( EC) 527 CMR 12.00
l(PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: a a
City or Town of: YARMOUTH To the I or of Wires:
By this application the undersigned gives notice f his or hfr intention to perform the lee 'cal work described below.
Location(Street&Number) ,/ G n T //v C It 0 C. k(i. IC. 10
O �G O� � � )
Owner or Tenant v kp 4L/ )ye ��
I Te hone No.
Owner's Address /64 C.ire tl l C 'O Cie EtC ,Cj
Is this permit in conjunction with a building/' permit? Yes No.0 (Check Appropriate Box)
purpose of Building `/s.F/4S45isiN (' 400i11
Utility Authorization No.
Existing Service/0 0 Amps J,2,0 /M'O Volb Overhead fir Undgrd 0 No.of Meters /
Hew Service Amps / Volts Overhead 0 Undgrd g ❑ No.of Meters
Humber of Feeders and Ampacity '
Location and Nature of Proposed Electrical Work: /E f E V OA p i T h J/ ./ c-Ff I A CLE$
Lit Completion ofthefollowing,table main be waived by the/ for of Wires.
No.of Recessed Lu�aiwdres No.of CeO.-Susp.(Paddle)Fans No.of T
Ho.of Luminaire Outlets No.
No.of Hot Tubs Generators KVA
No.o[Luminaires 3 Swlmmiag p� Above In- Ivo.of Emergency Ligating
No.of Receptacle Outlets 9 No.of Oil Burners FIRE ALARMS (No.of Zones
No.of Switches
v.
No.of Gas Burners Xi.of Deteeden and
11! Na ofInitiating Devices
Ranges No.of'Mr Cond. TOmt No.of Alerting Devices
Tons
No.o[Waste Dlsposers Heat Pump Number(Tons W 'No.of Self-Contained �
Totals:I_ [ ~"--- _— Detection/Akrtia
No.of Dishwashers Space/Area Heating KW Local 0 Mnoidp�
No.of Dryers Heating Appliances KW Seearriy Catena. ® 0 Other
No.of Water No.of No.of Ihvlca•or Equivalent
No.of
Heaters KW Signs Ballasts Data Wiring:
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiling:
OTHER:
No.of Devices or Eat
Estimated Value o Work , ,0.�, Attach additional detail if desired,or as required by the Inspector of Wires.
(When required by municipal policy.)
Work to Start a Inspections to be requested in accordance with MEC Rule 10,and
INSURANCE O GE: Unless waived by the owner,noupon completion.
�licenseepermit for the performance of electrical work may issue unless
provides proof of liability insurance including" ompleted 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:)
I ctrl& under dye paw and penaof pesyy,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.)
Address: Bus.TeL No.•
*Per M.G.L.c. 147.s.57.61 security work requires Ale.TeL No.:
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
SOwa Y By myY pure below I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
iv �
°a 13 flie Telephone Naf/3`a 416-�FsO (PERMIT FEE:S