HomeMy WebLinkAboutBLDE-22-004069 Commonwealth o/ addaekadelfa Official Use Only O,
+- ' , ft c cc7� n Permit No.�� 4 0l0
G fi 'y ..Vepartment oI.tfre Serviced
- l; ;" Occupancy and Fee Checked
y.' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code EC ,527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION),/ Date: 1l A ,Zo2..
City or Town of: ,nb h4 O lk-V t To the Inspe or of Wires:
By this application the undersigned gives tice of his o her intention to perform the electrical work described below.
Location(Street&Number) �1 C h (/�-�'i r ' ia,
Owner or Tenant 1.4 p 1111 �J 3.o hid-�Ptrl/1 5 w�, �Y-�i Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No ® of i :. ; . .ropriate Box)
Purpose of Building Utility Aut I 4,, on.; l . �
III a
Existing Service Amps / Volts Overhead ❑ y,0I U, • ` * SWil
b
New Service Amps / Volts Overhead Undgrd P ❑ g fy-�hTo�"9i��Meht'/e'
Number of Feeders and Ampacity cP 4 ..
si
Location and Nature of Proposed Electrical Work: [A) •e 4-- -f(,(�j •,.;r4.4 r,, "�
Completion of thefollowinq table may be i d s ector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tr of 1
Transformers A
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting
grnd. 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 Detectionn and
lnitiatinQ and
No.of Ranges No.of Air Cond. TotalNo.of Alerting Devices
Tons
No.of Waste Disposers Heat PumpNumber Tons KW Detection/No.of Self-Contained
Devices
Municipal
No.of Dishwashers Space/Area.Heating KW Local❑ Connection ❑ Other
No.of Dryers Heating Appliances KW Security
of De k or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications c o Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value f Ele 'cal Work: jO C6- (When required by municipal policy.)
Work to Start: 23— Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE GE: 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 [1] BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of pedury,that the information on this application is true and comple
FIRM NAME: Cape Cod Electrical LIC.NO.: 22642-A
Licensee: Nick McElroy Signature ] LIC.NO.:670 Al(Business)
Of applicable,enter"exempt"in the license number line.) '"--Jimi,Tel.No.: 508-566-4489
Address: 381 Old Falmouth Rd.Ste 32 Marston Mills,MA 02648 Alt.Tel.No.:
*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 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ 5-0.80
Email: Office(acapecodelectrician.com