HomeMy WebLinkAboutE-09-668 # 108 Electrical PermitsCommonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No. U6 1 c-
lQvv BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
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(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 / 17/2006
City or Town of. YA"OUTH, MA 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) 121 CAivir ST., UNIT 108
Owner or Tenant GATEWOOD HOMES Telephone No.
Owner's Address 1600 FALMOUTH RD UNIT 25 CENTERVILLE MA 02632
Is this permit in coniunction with a building permit? Yes X No ❑ (Check Appropriate Box)
Purpose of Building SINGLE FAMILY DWELLING Utility Authorization No. 1499045
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
' New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1
Number of Feeders and Ampacity
7Z
Location and Nature of Proposed Electrical Work: WIRE HOUSE, INSTALL SERVICE
No. of Recessed Fixtures
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No. of Ceil: Susp. (Paddle) Fans
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No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of T ;^h+ �^ Fix-tures
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Cevin:minr- pool Above In-
b = rnd. grnd.
o. o -Emergency Lighting
I fla!tm 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
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting D
g Devices
of Waste Disposers
Heat Pump
HeatNo.
Totals
Number
Tons
KW
No. of Sel - ontained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
No. of Water KW
Heaters
Heating Appliances KW
No. of No. of
Signs Ballasts
Security Systems:
No. of Devices or Equivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
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:) 10/31/2006
e\ Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date)
Work to Start: 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.
�L _A,FMM NAME: PATTON ELECTRIC INC LIC. NO. A15542
ZLicensee: RICHARD PATTON Signature LIC. NO.:
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No508 539 0200
Address: PATTON ELECTRIC INC. PO BOX 1525 MASHPEE MA 02649 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 a ent.
Owner/Agent n nat.>.T >cz>c. »e Signature Telephone No. I 1 Ll�L►jll 1 ZFE S l2.,,ou