HomeMy WebLinkAboutBLDE-23-8237 - image 29805.ffi""*monweatth of-\- Massachusetts
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BOARD OF FIRE PREVENTION REGT'LATIONS
Pcrmit No
Omcial Usc Only
BLDE-I9{02611
Occupancy and Fce Chccted
tRcv.tl07|
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
I All vork !o bc pedoredd in.clod.ncc eith tt Ma$.chusrB Etcctic.t Codc (MECI 527 CMR 12.00
(PLEISE PNNT N NK OR TWE ALL Dr'FOR,V,IIION)Dat€:10a r2014
City or Toin of:
By thir .pplicstion thc urdcrsigncd giv@trt dcscribed bclou
YARMOUTH fo the l,sp..tot o! tfint:
LocrtioD (Strc.t & Nuob.r) 36 APPLEBY RD
O?DcrorTGDrDl FERREI M
Orvnar'a Addretr 35 APPLEBY RD, WEST YARMOUTH, MA 02673
Tclcphouc No.
It ttb p.rEit ltr .oDjrD.doD wlth r b ldlng PcrElr?
Purpo* of Bolldio!
Erlrtiag Scrvicc / _ ltnp"
N.w S.rvlc. i _.foprN[Ebe] of F..derr rtrd AEp.clty
Y6 O No 0 (CDcck Appropr'retc.or)
Ulillty Autiorizrthr No.
Voltt
Volt!
No. of Meter.
No. of Mclert
Ov.rt.rd O Undgrd tr
Ovrrlcld O UEdgrd O
lrtrdon rld N.lurc ot Propor.d El.clric.l worl: lnstallalion of solar PV systBm (48 Panels)
on fiay wsived by ,he l$pectot lfiles.
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Estimatcd VEluc of Elccrricrt wort:
Wo* to sta.l:
or a, r.qdr.d by th. INpcttot
(Whcn rcquired by municipal policy.)
to bc Gquestcd in sccordarcc with MEC Rulc lQ and rpon completioD.
Llccnrcc:R Smith Sign.ture
(lfapplicabh..tta.r '.x.t,,.pl" in ti. li..nte ;ufibcr
rAddrcrr: 30 tST ST, MELROSE MA 021764010
'Per M.G.L c. 147,s, 57-6 I , sccurity worl rcquirB De[,artrncnt of Public Safcty ,S" Liccnsc:
Sigo.trr.T.I.photcNo.FEE:EI50.00
lNslrRANcE C0!'ERAGE! Utrlcss wtiYcd by 0u owncr, no pcrmit for Gc pcrformaacc ofelecuical wort may issuc unlcss the licenscc
Prolides prcof of li.bility insurancc including 'completed opeDtion' covcragc or its lubsrantial cquivalcnt. Tho unde$igncd c.rtifies thst such
covcragc ir io forcc, snd has cxhibi&d proofofsaDe to thc l€Ioit irsuirlg oftrcc.
CHECK ONE: INSURANCE O BOND tr OTIIER tr (Specify)
I ictdfy, udct thc peias cid pe a.ld6 of pe lary, th.,l ,h. lrrtor ation on rtis application ls n c rnd compl.ra
trTR.v NAiIE: IIOYD R SMITH
LIC NO,: '15688
owNER's INSURANCE wAIvEk I rm 8w.E ual tic Licctrrc doet ,ar rdE thc liability inslrancc covcagc nomElly rcguired by law. Butsignaturc bclow, I hcrcby waive this rcquircment. I rm the (chcck onc) O owncr rf owueis ogoriOs!cr/A8ctrt
Brt. TlL No.:
AIL TtL No-:
adt (,?[n e
catnwr t! ae<a ,fu/oa_druoNtnD
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No. of Rccaocd Lunhrlrcr No. of Ccll.-Sury.(Prddlc) Fenr No. ofTrr[!fornrrl!TorrlKVA
No- of Lumlnrirc Oullet!No. ofHol Tobr KVACaDarrtort
No. ofLumlnrlrcr Ia-grDd,o trswltllmlng Pool HJ€No. of Ughring
No. of R.ceptrclc Oofletr No. of Oil Bomrrt FIRE ALAR, IS No. of ZoDGt
No. of Swltch.t No. ofGrs Bumers No. of Datcclion indInitl.tlns DGrdcpr
No. of Ruger No. olAir Cord.ToldTont No. of Alertiog Devlccr
l{umbcr Tonr KWNo. of lf,utc Dlrpmcn H..t Pu6pTotrls:No. ot Sclf-Colt.iocdD.lattion/Al"filno Devl...
No. of Dishwrshrrr Sprcc/Arc. Il.rting IcW L,otel tr Iuuoiclp.t
Co[nectlon E Otier:
No. of Drycrt EcrUog Appliru..r KW Sacorltv Svrlemt:r
No- of Devlcc. or Edulvrlont
Krl'No. of Wrl.rll?.terr No, ofBdhittNo. of
Sisnr
Drt Wlrlng:
No, of Dcvlce! or EoulYrlent
No. Ilydromr!titc B.thtub.No. of lllolorr TOI'I HP TcletotnuroricitioDr Wlrtng:
No. of Devlcor or Enuivehn'i
OTIIER:
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