HomeMy WebLinkAboutBLDE-25-1667 Commonwealth of Massachusetts Official Use Only
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Department of Fire Services Permit No. 'LS—•«V�
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPEL;A INFORMATION) Date: / p- —/ —a-S
City or Town of: T a rn,o;n:4-1-r 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) E____OVQ- (2-4a 'mart 2tivies
Owner or Tenant 4/1G� @ Q,/.� Ssuc-t`e' 'ejj��h c..;Girt5p,a3 hL Telephone No.S -33'$=J.` c''f-
Owner's Address /35 A' '-'f /3 P,D.(3`'X 7 1Tcl E.�Qis,i 5 AY/ 016 V/
Is this permit in conjunction with a bui ding rmit? r No (Check Appropriate Box)
Purpose of Building P-e-sA Aer 117,t I Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Z--6W Vo h S ,S t_s ,-,. c...go
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Completion of the following table ma be waived by the mope or of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA
No.
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above grnd. ❑ In- ❑ No.of Emergency Lighting
grnd. Battery Units •
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 2
n
No.of Switches No.of Gas Burners No.oInitiaatting Dn Dng D and evices
/ C
✓
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 9
No.of Waste Disposers Meat Pump Number Tons KW No.of Self-Contained 9
Po Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Local❑Municipal
P Connection
No.of Dr ers Heating Appliances KH, Security Systems:* /�
Y No.of Devices or Equivalent -/
No.of Water Kµ, No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Eqquivalent
No.H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsN.ofDDevices
or Equivalent
Y g /' No.of Devices Equivalent
OTHER: pahl r 6_s zn' t- ' !c-ydJc,ci '��(tic+r�ert (3)
no Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: �it9 CI u (When required by municipal policy.)
Work to Start: /.Z-/ -. .S Inspections 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 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 7•. BOND ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Seaside Alarms inc LIC.NO.: Iil7f
Licensee: Robert K.Boucher Signature. 1.12ts.ow-"LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: .08-394-0c99
Address: 265 Route 28,South Yarmouth.MA 02664 Alt.Tel.No.:
*Security System Contractor License required for this work;if applicable,enter the license number here: S-0046
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 PERMIT FEE:S 4f 5
Signature Telephone No.
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