HomeMy WebLinkAboutBLDE-26-95 Commonwealth of Massachusetts Official Use Only
C
R E Department of Fire Services Permit No. v -4:4 J
I f Occupancy and Fee Checked
JPtN OARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank)
BU,I LDINC APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ay. - All;work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 0/— °�7 - --
City or Town of: Ili-v-n-t o tom' , 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)� 31 g'�c Q n -IA We•.f Po c cc
Owner or Tenant A lit c.(ta, --S-42i15 o ti Telephone NoSSub'- S-3o 9'
Owner's Address I/S S G,r(ne Ss P,"<-it, /k, cl ,4,14 642,S
Is this permit in conjunction with a building permit? No (Check Appropriate Box)
Purpose of Building ae-rtA`t+ 1t. .1 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: G-E,rJ //V��u,/' e/,S e-4,^.-+",
-rr.a ,...u- - CJe.-vv. S
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.ofCeil:Sus .(Paddle)Fans No.oof KVA
P Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool ncy LightingAbove In- Bao.a yEmerge
grnd. ❑ grn . ❑
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones /
and
No.of Switches No.of Gas Burners No.of Detectiong Devices
Initiatingp
/
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices //
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Pos Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑M Counicipalnnectio n ig OtFer"fv-f
�{ ..
No.of Dryers Heating Appliances Security Systems:*
ry KW No.of Devices or Equivalent .--
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wino
Y g r No.
tlof`Devices or Equivalent
OTHER: C„.�-eon. >nxX�ae cF i r'(3) n -1 c. cti`' 44.-± ,,-(1)
p,. Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 3.aO— (When required by municipal policy.)
Work to Start:D/-fib'.---(, 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 .`, 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: Jeaside Alarms inc LIC.NO.: 1317C
Licensee: Robert K.Boucher Signature fW O&cd'ow--LlC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: FOR-394-0599
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: '-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:$ `71 5.
010
Signature Telephone/No.
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