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WPS - Permit
Work Order Information
Utility Auth/WO #: 01543090 Date: 09/15/2006 Company BEA LORD
Rep:
Report By: YAR 121 CAMP ST U90 VILLAGES AT CAMP ST LLC
Status: ACTIVE Service: NEW Type: RES
Nature of Work: CONNECT 100A 120/240V UG IN HH190D
Service Information:
There is no Service Information.
Permit Information
Permit #: E07-0000 Meters: 1 Reseal (Y/N): Y Date: 10/18/2006
Inspector: W10060 Description:
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http: //www. nstaronline. com/apps/wps/wpspermit. cfm?Page=Permit&Unique= { ts_' 2006-... 10/18/2006
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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
TOWN OF YARMOUTH
(OFFICE USE ONLY)
By
Fee: $ / ly
6-d
PERMIT NO. 161 "b C F-07 _ 1--Ct,
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below.
Location (Street & Number) 12
Owner or Tenant <76 P_ We a C$ Telephone No.
Owner's
G e<�Q r{fi "-( C -PA � 'e",
Is this permit in conjunction with a building permit? 71 Yes 71 No (Check Appropriate Box)
Purpose of Building x6w44V Utility Authorization No. l S L, _?6 14
Existing Service Amps / Volts Overhead Undgrd 71 No. of Meters
New Service /a o Amps yd /gad% Volts Overhead Undgrd L No. of Meters
Number of Feeders and Ampacity.
1 1
Location and Nature of Proposed electrical Work:
i ",e
ompletion of the following table may be waived by the Inspector of Wires
N. 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-
SwimmingPool rnd. grnd.
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. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
— — —
Tons
— —
KW
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 71 Municipal Connection Other
No. of D
Dryers
ry
Heating Appliances KW
g pp
Security 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.
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
force, and has exhibited proof of same to a permit issuing office. /
CHECK ONE: INSURANCE r BOND � OTHER[D (Specify:) �(/ � ) C l �` �j��� / % ?
(Expiration Date)
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.
I certify, under the �% and penalties of perjury, that the information on this application is true and complete
RM NAME:L� < < L LIC. NO. (�c
censee: Cl- 4w.e Signature LIC. NO.
(If applicable, enter exempt" in the license numb r line.) i Bus. Tel. No.:
Address, A,-, Alt. �s-v?��d� —/� �� Alt. Tel. 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. I am the (check one) owner 71 owner's agent. 71
Owner/Agent
Signature Telephone No.
[Rev. 04/00]