HomeMy WebLinkAboutE-07-152 #82 Electrical PermitsL--]
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY)
TOWN OF YARMOUTH By
Fee: $
PERMIT NO. eP- r -, 0 -7 — I
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application the ndersigned gives notice of his or her intenlionW perform the electrical
work described below. c
Location (Street & Number)*�-v
Owner or Tenant G � ephone No.
Owner's Address l 1i �U
4
Is this permit in conjuEtion with a building permit? Yes No (Check Appropriate Box)
Purpose of Building_ ���_ Utility Authorization No.
Existing Service Amps / Volts Overhead Undgrd [71 RIIE.
New Service kOO Amps t Volts Overhead7l Undgrd No. Meters
Number of Feeders and Ampacity - 'l.7 f AUG 1
Location and Nature of Proposed e ectrical Work: J BUl
BY: --
Com letion o the 11owing table m be waived by the Inspector of Wires
No. of Recessed Fixtures
No. of Ceil.-Sus . 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 grnd. gmd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. o Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Num er
— — —
Tons
— —
KW
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal Other
Local Connection
No. of Dryers
rY
Heating Appliances KW
g pP
SecNo. Systems:
No. of Devices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa e Bathtubs
y g
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
5 INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
and has exhibited proof of same to the permit issuing office.
,-)tfbbrc,e,
HECONE: INSURANCEeBOND rl OTHERCI (Specify:)(Expiration Date)
tmated Valueo El trical Work: (When required by municipal policy.)
ork to Start. t Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the and en of , that the information on this application is true and complete.
aRM NAME: LIC. NO.
censee: Sign tore LIC. NO.
(If applicable, mr exe pV ensk number lind& Bus. Tel. No.:
Address Alt. Tel. No.: ttic—
OWNER'S INSURANCE WAIVER: I am aware that the Licensee d es not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check e) owne ❑ owner's agent. 71
Owner/Agent
Signature Telephone No.
[Rev. 04/001