HomeMy WebLinkAboutE-06-046 STP Electrical PermitsCommonwealth of Massachusetts Official Use Only �L
Department of Fire Services Permit No. —� _ �V
• Occupancy and Fee Checked SD, 07)
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (leave blank)
AAC Job
212A APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical codd l 527� 1
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L
City or Town of: Yarmouth To the Inspector, of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described 6e oUy.
Location (Street & Number) 121 Camp Street jut
Owner or Tenant Village at Camp St. - STP E`"Itelephone No.
11
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building Commercial
Existing Service Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Yes ❑ No Q (Check
Utility Authorization No.
Overhead ❑ Undgrd ❑
Overhead ❑ Undgrd ❑
kppropriafe
No. of Meters
No. of Meters
Install burglar alarm devices
Comnletion of the following table may be waived by the Insnector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
TransTotal
Trsformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool ❑ In- ❑
rnd. rnd.
BAbove o. o mergency Ug mg
atte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. o DetectionidInitiating 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
Municipal El Other
Local ❑ Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or E uivalent
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 11 A - LIC. NO.: A4776
Licensee: Paul M. Rich Signature �AG�� LIC. NO.: A4776
(If applicable, enter "exempt" in the license number line) �Bus. Tel. No.:7 81- 3 3 7 - 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 agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ 100. 00
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