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HomeMy WebLinkAboutE-14-589l.ommonmia& of tt/adsac"lft Official Use OnlyQQ 28,8 rlme/rf of 5M se vied Permit No. ��� U9 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fce Checked ev. 1/071 • eave blank APPLICATION FOR -PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code WC). 527 CMR 12.00 M(PLEASE PRINTIN INK OR7YPEALLINFORMATIOA9 Date: ', / // City or Town of:S'ARMOUTH To the Inspector o WWires: ZIN iy this application the prtdcrsigned groes notice of his or her intention to perform the electrical work described below. --I J Location (Street &Number)/f/ r, fi tH i� .� wner*or Tenant C= G Telephone No. e wner's Address ` ••0 e,a this permit in conjunction with a uilding permit? Yes ❑ No © (Check Appropriate Boz) q F— P rpose of Building (/� v / ro y Utility Authorization (-' � horization No. (f,. r=) I ° isting Service ioy Amps /26 /tl, Volts Overhead Undgrd ❑ No, of Meters f ? I . Service /ori Amps Ltd / �y0 Volts Overhead ✓❑ Undgrd ❑ Nti. of Meter _L Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -P /C!- �t- � tC h/ c2ne yyGtt.� �v�fC� 7' Lb A No. of Recessed Luminaires e wm tenon of me jollowin table m be waived;the1nSDejCIor0 Woes. °• ° No, of CeiL-Susp. (Paddle) Fans Toal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ o. o mergencung rnd. zrnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Barriers o. o etecd—on and Initiating Devices No. of Ranges NTotal o. of Air Cond. Tons No. of Alerting Devices No, of Waste Disposers eat mp umber ons o. of el ontaine Totals: IDetection/Alertin� Devices No. of Dishwashers Space/Area Heating KW Lor ❑ unki ❑ Other Conn et'aon No. of Dryers Heating Appliances KW becurity Systems:* o. of YvaterNo. Heaters KW 0 01 N. of Devices or E uivalent Data Wiring: ns Ballassf ts SigNo. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunicanons Wiring: No. of Devices or E uivalent OTHER: ••••- ... J ""&rte Prax requrrea by me Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C ERAGE: 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 2" BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: / LIC. NO.:/y` /�� Licensee: ��,/,, / `, jIf _ Signature LIC.NO.:/y/77/� Addreicable, enter " empt' in the t ense num er line.) / us. Tel. No.:._CDP A7 / �L J License: 41t. Tel. No.: •Per M.G.Q. c. rg/, s: 37-61, security work req res Department of Public Safety "S" License: — Lic. No. --- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityinsurance coveragenormally required by law. By my signature below. I hereby waive this requirement I am the (check one)❑ owner ❑ owner's a cnt Owner/Agent JN Signature Telephone No. PER.AfITFEE. S NSTAR: Wiring Permit System (WPS) - Permit (Comments I Work Order Reauest I SearchI Int I wNSTAR Wiring Permit System (WPS) - Permit Page 1 of 2 - Work Order Information UtilityAuthMO #: 01963328 Date: 10/01/2013 Company Rep: Report By: YAR 29 NIGHTINGALE DR HAYES JOSEPH S Status: ACTIVE Service: Type: RES Nature of Work: REPAIRED AND REPLACED SE CABLE AND METER SOCKET, RESEAL ONLY .q.••- ., i• - Will 1=1_614 - bervice Information Service Voltage: 120/240-3 Switch Size: 100 Address: 29 NIGHTINGALE DR YAR 02664 Name: JOSEPH S HAYES Work Order Information I Service Information I Contact Information I Permit Information Contact Information Type: ELECTRICIAN License: 0000014177 Last Name: SHEPHERD First Name: DANIEL Company: SELF Address: 21 WAQUOIT LANDING RD E FALMOUTH MA 02536 - Pager: Email: Phone: 5085480396 Cell Phone: 5082746896 Fax: Best Hours: Blue Book N Reorder: Work Order Information I Service Information I Contact Information I Permit Information - rermn inTormation Permit #: E14-589 Meters: 1 Reseal Y Date: 02/03/2014 (YIN): Inspector: WI0060 Description: Work Order Information I Service Information I Contact Infornation I Permit Information ( Cornments I Work Order Reauest I Search I Ust I Copyright 2014 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction in whole or In part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result In criminal prosecution. https://www.nstar.com/secure/apps/wps/wpspermit.asp?Work_Order Nbr=01963328 2/3/2014