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Permit No.
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), MR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: March 24, `
City or Town of.• YARMOUTH To the Inspector ` „mires:
By this application the undersigned gives notice of his or her intention to perform the electrical v bkik d oed-b f
Location (Street & Number)121 CAMP ST # 1
Owner or Tenant ELAINE RICHARDSON Te¢one No. (617) 584-5681
Owner's Address 4 CHARLES GATE EAST #802 BOSTON MA 02215
I this ermit in coni unction with a building permit? Yes ❑ No ✓❑ (Check Appropriate Box)
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Purpose of Building RESIDENTIAL Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: INSTALL SECURITY SYSTEM
PLEASE FAX PERMIT AND PERMIT# BACK TO US AT: 508 398-5666. THANK YOU
Co lotion aftho fallowing table may be waived by the Inspector of Wires.
No. of Total
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool rnd. ❑ rnd. ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Detection and
No. of Switches
No. of Gas BurnersTotal
Initiating Devices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
Heat Pump
Number
Tons
KW
No. of Self -Contained
No. of Waste Disposers
P
Totals:
..... ....
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal Connection ❑ Other
No. of Dryers
Heating Appliances KW
Security Systems'8
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
I No. of Devices or E uivalent
Telecommunications Wiring:
No. H dromassa a Bathtubs
y g
No. of Motors Total HP
No. of Devices or Equivalent
OTHER:
Attach additional aetaii ej desired, or as required by ine tnspecwr vj r. ties.
Estimated Value of Electrical Work: $635.00 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion.
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 0 BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Cape Cod Alarm Co., Inc. LIC. NO.: 1592C
Licensee: GENE CORMIER Signature's ��z�-H .<✓ LIC. NO.:
(Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508 398-6316
Cl Address: 204 OLD TOWNHOUSE ROAD WEST YARMOUTH. MA 02673 Alt. Tel. No.: 800 468-8300
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS CO 000248
'S- 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 PERMIT FEE: $ 45.00
Signature Telephone No.