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HomeMy WebLinkAboutBLDE-24-1241 _ �olrrxoe..re'eaith of/ua6arh.,.c.e _ .. L Official Use Only nPer:.._t No- `-"" 1 22_.-�__ q cow:scan al 5 :rc cr✓Cce: -�� _- a Occ�aa cy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ,Rey. 1/07 Qeave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work ro be n.rfo. ed;i aocn noe w:'1:tHe Massaehuse_s Eicct ici Cede C),5277 CM ?R 1 00 PL EASE PRINT IN INK OR TYPE ALL N Q M4T?O ) Date: -7 - J 34 City or Town of: YARMOUTH To the Inspector of Wires: ® \ . F-3y..Elis application the t]:nder_isy:ed c:✓es notice cf, s or ner irteO n to Yrfo.Tm the electrical m Work deSCred below. 4 5.4 ation(Street&Number) S 7- .D C sue.la `o �!-0- er or Tenant U...7 CSC V iN,Q y (�7.4 l0L-,Z ( Telephone No. AA. {� O ,TirO• •er's Address S j fr 7 w [LI{h c''J tIs is permit in conjunction with buiding permit? Yes ' i No (Check Appropris f z) �' ZP ose of Building • . Lu.J�'S-1 J S��,Jo�.t`7, y, U3iitz Authorization No. 7 W5 j —' i`JE ling Service3�(;vAm )v ps 1 !a,4CVoits Overhead Undgrd Z, - No. of Meters I Ce Pe Service Amps Volts Overhead Undgrd Li No. of Meters Number of Feeders and Ampacity jC.-ZD M_C_i >( D-i) Location and Nature of Proposed Electrical Work: L.. A U 6= (6 GC .1•1..tTh F is ) Ccmplet'.on of thelollaw'r.?table may be waived oy the Irsoecior of Wires. INo.of Recessed Luminaires No.of CeI1.-Suss.(Paddle)Fans !To.of Total Transformers !-!- o.of Luminnire Outlets INo.of Hot Tubs Generators KVA No.o - . opines J�Tmminn Pool Above In- I , 1No.of r:xaerQ-- , l.igncmg artxd. —j crud. -- Battery t No. of Receptacle . - i No.of Oil Burners iF i= - ALARMS iNo.of Zones No. of Switchesof Gas Burners o.of Detection and I nitiatias Devices No. of Ranges No.; of Air ..• Ta.5 No.of�lertin Devices I Heat Pump i Number KW No.of Self-Contained'No.of Waste Disposersff � Totals: 1 I 1Deteetion/AIertias Devices No. of Dishwashers Space/Area� . ating KW Municipal Connection ❑ ?_ INo. of Dryers---1j Head• Appliances.. of KW Ballasts Secure stems:' I No.of II ,.c_es or Equivalent � e, No.' of Water Heaters 5i;ns No. of Data Wiring: 1 No.of Devices or Equivalent !`+ iNo. Hydromassage Bathtubs [tio. of Motors Total HP Telecommunications Wiring: IIi No.of Devices or Equivalent IOTHER: - ✓ ©tom rrrock additional detail j"desired or as required by the Inspector of Wires. Estimated Value of Elecuical Work. lC00 (When required by m'nicipal policy) Work to Start: Ins ections 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 incluriing"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. �NJ CHECK ONE: INSURANCE (,� BOND Li OTI-ER U (Specify:) _ I certify, under the paints and penalties of perjury, that she information on this application is true and complete. FIRM NAME: Co L t,'ec.-C(10-- b. l--4.-tGs-9-i LIC.NO.: l,S'(pli..6 Licensee: i..Z- 1�l (o Signature ;`� / LIC.NO. 3 L{ I a Dlicabl enter " t' license. line.) A �f P. �•empt"'tr,the cerse •mDer..ne j !!Address "t�� t� .GN lfii�F'r P1 O���c , Mt Bus.Tel.No.: .�6 - -'`�77 f 1 *Per M.G.L. c. 147,s.57-01,security work requires Depa,anent of Public Safety"S"License: TeL No. a 2y C OWNER'S INSURANCE WAIVER: I am aware thee.the Licensee does not have the liability insurance coverage n— o— — Sy required by law. By my sia^ature below,I hereby waive this requirement I am the(check one) ❑owner ❑owner's agent i Owner/Agent f Signature Telephone No. I PERMIT FEE: $ I