HomeMy WebLinkAboutBLDE-24-1938 RECEIVED
DEC 12 2024
Co atth o� aeeachueaffe Official Use Only
�'^ '"'� DING DEPARTMENT f i Cf 3 (f)
tZ i cc77 �n7 Permit No. l '. f r
"f:Ti[' — 2 insnf el.}ire Servicse
:i(- Occupancy and Fee Checked[Rev.
— �. BOARD OF FIRE PREVENTION REGULATIONS
1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRI AL ORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C R 12.00 , /
2
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ii 1y
YARMOUTH Inspector of
Cityor Town of: To the Ins ector fires:
By this application the undersr i otice of s or her intention to perfo e e c cal rk described below.
Location(Street&Number /Y/14�ld ''1•1 i i (
IA Owner or Tenant I i '� Telephone No. `jli�d
1 Owner's Address //" 7(-'
Is this permit in conjunction with a building permit? Yes C No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
1 Existing Service /t,) Amps / )/ ?4 Volts Overhead Undgrd P1 No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
�� Number of Feeders and Ampacity �i, 2,1 t
Location and t Proposed Electrical Work: / ix;i let ' :6,- '-1�V
/!/ ' c
Vt Completion of the following table o ey be waived by the hrspector of Wires.
l.is No.of Recessed Luminaires No.of Ceil:Snsp.(Paddle)Fans No.of Total
(,` Transformers KVA
�1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
t1
A.mot;; No.of Luminaires SwimmingPool ove ❑ n' ❑ Bate N rgency Lighting
�rnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
•= No.of Switches No.of Gas Burnersv. Initiating Devices
I I! No.of Ranges #j�1,t/�^I No.of Air Cond. Tonsl No.of Alerting Devices
No.of Waste Disposers ` Heat Pump Number Tons KW 'No.of Self-Contained
p Totals: ,Detection/Ale r ting_Devices
No.of Dishwashers Space/Area Heating KW Local❑ un mpa 0 Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices 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 Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of El is ork: (When required by municipal policy.)
Work to Start: i ' ,;' Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE O 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"comp ted operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has ex ' ited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND 0 OTHER (Specify:) Z-U4//i e-X,Ce,..7. , e. // c
I certify,under the pains and penalties of perjury,that the information on this application is true and complete. /
FIRM NAME• LIC.NO.: .� ` r
Licensee: , lia Signature • •, LIC.NO.: >t�)
(lfapplicable,.apte 'ezem,t"in! etl:c z- nu be. its•.) 1 , ' / ' Bus.Tel.No.• 6--
ill/6
I J/�-
Address: / 4 / I ` / . ' Alt.Tel.No.: _ /c
*Per M.G.L. . 47,s.57-6 ,security work requires Department of'ub is Safety"S"Lic se: 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 ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $