HomeMy WebLinkAboutBLDE-23-003547 RECEIVED
— aa// qq��DEC 05 2021, aalih of rrlaeeae/iaeaile Official Use Only
ki,„tig-: Nc nt -ART nio/cc77 ire S rvicoo Permit No.
.;.�I -------_------- Occupancy and Fee Checked
s BOARD O REVENTION REGULATIONS [Rev.1/07j (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME ),522 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 12/57Z02 2-
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) S9 C ff)rf 1,4 G GREE4.1 CI&
Owner or Tenant PO DARR-5 D 1 AIs1Y Tit Telephone No. _
Owner's Address
Is this permit In conjunction with a building permit? Yes No E (Check Appropriate Box)
Purpose of Building RCS,DENT q-s.. Utility Authorization No.
Existing Service Amps / Volts Overhead Undgrd
❑ g ❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: gmilioom REMODEL
' Completion rf the followingfable;mg be waived by the Inspector of Wires.
tin No.of Recessed Luminaires / No.of Cell:Snsp.(Paddle)Fans Transformers KVA
nNo.of Luminaire Outlets No.of Hot Tubs Generators KVA
do No.of Luminaires / Swimmia Pool Above In- 'No:of Emergency Lighung
g grnd. grad. ❑ Battery Units
- No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones 1
No.of Switches 3 No.of Gas Burners No.of Detection and
Initiating Devices
11
No.of Ranges No.of Mr Cond. Tons) No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: - - ""'""'--""- "" -. Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑Monnectiunicipaonl Ei Other
No.of Dryers Heating Appliances KW Security No Systems:*
Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters 1CWSigns Ballasts
g No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
LT /,,_I No.of Devices or Equivalent
OTHER: I I X N-RVJ r ram"'
Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of EI trical Work: 3, D (When required by municipal policy.)
Work to Start: 12 7IZ Z.- Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO RAGE: 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 Ig BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the Information on this application is true and complete.
FIRM NAME: JP,V)ES 14yrcmI,4S LIC.NO.:
Licensee: ,TRmE3 HUT 0{0.45 ..T Signature ] „.,-ILL—LIC.NO.:21 5/iz.
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No..
Address: ?8 Cukref Mt l\ LN hlANO V V(- 0 A
AI[. No.:
.Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No.
OWNER'S INSURANCE WAIVER: I ant 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 eat.
Owner/AgentPERMIT FEE:$
SignaturetuneTelephone No.
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