HomeMy WebLinkAboutE-09-299 #90 Electrical Permits4
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEQ, 527 CMR 12.00
TOWN OF YARMOUTH
EPo�
(OFFICE USE ONLY)
By
Fee: $
PERMIT NO.
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application e undersigned gives notice of his or her
work described below.
Location (Street
Owner or Tenant
Owner's
-0'7- c P
to perform the electrical
Telephone No.
Is this permit in conju tion with a building permit?,P'Tes ONo (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps_
New Service t5ID Amps
Number of Feeders and Ampacity.
Volts Overhead0
Location and Nature of Proposed electrical Work:
Undgrd 0
No. of Meters
No. of Meters 1
Completion of the, following table may 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 71 In-
Swimming Pool grnd. 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 an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat rump
Totals:
Number
— — —
Tons
— —
KW
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 7j Municipal Connection Other
No. of Dryers
Heating Appliances KW
Secutity 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
J 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 C1 OTHER (Specify:)
(Expiration Date)
Estimated Valu El ctrical Work: (When required by municipal policy.)
Work to Start: —1 O Inspe tions to be requested in accordance with MEC Rule 10, and upon completion.
I certify, unde th& s and ltie jury, that the information on this plication is true and complete.
RM NAME: LIC. NO.
censee: Signature LIC. NO.
(If applicable, nter "exempt ' in the license number line.) Bus. Tel. No.:
Address-, 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 owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 04/001