HomeMy WebLinkAboutE-06-045 Pump Station Electrical PermitsCommonwealth of Massachusetts official Use only
r Permit No.
•
Department of Fire Services
Occupancy and Fee Checked /6v1/v
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (leave blank)
AAC Job
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212E
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WCRIC
All work to be performed in accordance with the Massachusetts Electrical Code (NjEG) �a7 CI 2 1�.OQ �+
MCI
"7
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L 14 �u!v'� ��
City or Town of: Yarmouth To the Inspector of Wires: XUL j 8�7S
2005
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 121 Camp Street
Owner or Tenant Village at Camp St. - Pump Station Telephone No
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box)
Purpose of Building Commercial 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: Install burglar alarm system
Completion of the.following table may be waived by the Inspector of Wires.
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No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above ❑ In- ❑
Swimming Pool rnd. rnd.
o. o Emergency Lighting
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. o Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
I.
Tons
I
KW
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems: r
No. of Devices or Equivalent 7
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
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.
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 x❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Now Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Atlas Alarm Corporation 14 4 LIC. NO.: A4776
Licensee: Paul M. Rich Signature LIC. NO.: A4776
• (Ifapplicable, enter "exempt "in the license number line.) V Bus. Tel. No.,781-337-8866
Address: 1239 Washington Street, Weymouth, MA 02189 Alt. Tel. No.:781-337-8866
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) ❑ owner ❑ owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE. $ 100. 00
/Aw /►.