HomeMy WebLinkAboutBLDE-26-436 �_ lloirmonte,c /t of///a-'3achuse 3 ,.t: rOtncialUse Only
g W �f [7 Permit No. G 2 C - l'i 3 Co
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS er. I/07] (leave blank)
APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK
AU work to be performed i-t accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.0�//
(PLEASE PRINT IN INK OR TYPE ALL INFOReL4 TION) Date: 3 - '- lr.0 )
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the pndersi ed gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) U 9.< L
Owner or Tenant L t IS 1N t Telephone No.1744,-70,7..--2.9qe
Owner's Address 5, A hC42-
Is this permit in conjunction with a bui ding permit? Yes ❑ No g. (Check Appropriate B x)
Purpose of Building c.V eL\k,'k.C9 Utility Authorization No. At
Existing Service I U Amps V/ .C)Volts Overhead 12r- Undgrd Li No.of Meters t
New Service Amps / Volts Overhead L_ Undgrd E No.of Meters
Number of Feeders and Ampacity 9 A I
Location and Nature of Proposed EIectrical Work: W l O t ,Q a—
Completion of the following table may be waived by the Inspector of Woes.
1No. of Recessed Luminaires _Vo. of Cei1.-Susp.(Paddle)Fans Transformers Total
Transformers !.„.:-
o.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.o - .'mires Above --I In- ❑ o.of r.mera-. ahttng
Swimming Pool arnd. IJ grad. Battery U
No. of Receptacle . - of INC.of Oil Burners Fie - ALARMS IN°.of Zones
No. of Switches C..of Gas Burnerso.of Detection and
Initiating Devices
•
No.of Ranges INo. of Air .. • To s No.of Alerting Devices
• Heat Pump Number "- • I KW tNo.of Setr-Contained
Totals: Detection/Alertini Devi
No.of Waste Disposers
ces
No. of Dishwashers ISpace/Area - ating KW' oval❑ Munnicipalnection ❑ �
L Co
No. of Dryers ,Hem Appliances Secu stems:*
No.of 1 ices or Equivalent
No. of Water s KW a. of No.of Data Wiring
eaterSigns Ballasts I No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
j No.of Devices or Equivalent
OTHER: -
oc� Attach additional detail if desired, or as required by the Inspector of-Wires.
Estimated Value of Electrical Work: �'l vo (When required by municipal policy)
Work to Start:3—vZ/A.—al, 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
1 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 ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: t 14 Co EL,E'c.1 QQ- ,lA4-4-i.C�'Z LIC.NO.: I.S-(:jl((.9
Licensee: . ZZ- I.._t f=,..(( Signature - !A ( LIC.NO..- 3
(If applicable,enreer "exempt"inlicense nz�mberline.) f t «! Bus.TeL No.• 56 _ -re 77y
Address. l�� CC.---N Ttiii- V1 Pr . O \..C2-Get. Alt Tel.No.: a 2z43 n y.
1 `Per M.G.L. c. 147, s.57-61,security work requires Department of Public Safety"S"License: 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. 1 am the(check one)E owner ❑owner's agent.
Owner/Agent
� Signature Telephone No. I PERMIT FEE: $ 1
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