HomeMy WebLinkAboutElectrical Permit �ommonwca.6th op ///a4dathst3e • .7' Official Use Only
I, _�t Permit No.
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{. ; % -:,_:_!r-__.' ;` 1 Occupancy 2nd Fee Checked
tk, BOARD CSF FIRE PREVENTION REGULA i IONS e�. 1/07} leave blank)
w - APPLICATION FOR PERMIT TO PERFORM ELECTRI ' ''1 WORK
Gi n > All work to be perfarnod in accordance with the Massachusetts Electrical Code(!EC),527 C t, 12.00
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LEASE PR?7r7.'IN INK OR TYPE.ILL INFORM4TIONj Date: 4,. /.R..9//
C" CitF r Ton of: YARMOUTH TH Tc the Inspector of Fires:
`Y By this application the ttnd � to
ersinned �es nonce of his or her intention perform the electrical work-described b.
,- -Location(Street&Number) 39 O C E A av 4 v LE S a y R is1. m i'4
__
Owner or Tenant .,j p Si; P 4 "„tiv t 6.4,4 4.1 Telephone No.
Owner's Address 5,444 4
Is this permit in conjunction with a building permit? Yes No ([}' (Check Appropriate Box)
Purpose of Building Ris; Dei cis Utility Authorization No. „Re. ce''j f is
Existing Service Amps Volts Overhead Undgrd f No,of Meters _
New Service ie 6 Amps f a� , 46 Volts Overhead l/ Undgrd C No.of Meters
Number of Feeders and Ampacity 3_...4 2 4 t_. 1on Arts P
Location and Nature of Proposed Electrical Work: ailAir,j1 ,g/)f C C.. £ 'F) f d.'.iP S *es.�,
fei,oc, ,F � ,QJtc ` _
Carnotatior,of the following table •be waived. the Inspector of Wires.
rNo.of Recessed Luminaires 1No.of CeiL-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets 1 No.'of Hot Tubs Generators KVA
Above 'In- No.of h.tnergeucy Ltglitmg
- No.of Luminaires Swimming POOL ?end.. Enid. I—, 'Battery Lusts 1
'NO,of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of SwitchesNo.of Gas Burners No•orbetection and
i - Initiating Devices
Total
INo.of Ranges 1No. of Air Cond. Tons No.of Alerting Devices
�No.of Waste Disposers ;HeatPump Number 'Tons i K4 d No.of gill:Contained
+ 1 —('�'�`_ DetectionAlertina Devices
!No.of Dishwashers Space/Area Heating KW Local 0 Iylunicipai 0 Other
Connection
1No.of Dryers !Heating Appliances KW II ecurity yyssttems:'' i
1No.of Water — No. of No.of 1 No•of devices or Equivalent l
l Heaters KW Ballasts !Data Wiring: I
Signs No.of Devices or Equivalent
INo.Hydromassage Bathtubs !No.of Motors Total HP Telecomn:itnicatioa j`'iring:
No.of Devices or Equivalent
OTHER: 1
Attach additional detail f de;:ireal oras revared by the inspector of Wires.
Estimated Value of Elect^ical Work: (When required by municipal policy.)
Work to Start: i.t)aE//4- Inspections to be requested in accordance with MEC 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 is substantial equivalent The
undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ' BOND ❑ OTHER ❑ (Specify:)
I cerr`fy, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:AAf f r S gi-ii c 7,d s C Z.'N'G LIC.NO.: 7g zg-
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Licensee: ,f/4se,ta j.e,,mg- Signature "21Lai 71/c,4 leer,5 LIC.NO.: ,717> 4"
t'Jf applicable, enter "exempt-in the license number line.) Bus.Tel.No.: 77S- 4'3 a 9'
Address:32e. e7. LLe._..c2/„..d c-e. C eig4 o Z ' N 8 Alt.Tel No.: Ela3A-e7 y3
t *Per M.G.L. c. !47,s. 57-61,security work requires Department of Public Safety"S"License: Lic. No.
vtzt
OWNER'S INSURANCE WAIVER: I arr. aware that the Licensee doer.nor have the liability insurance coverage normally
5 required by law. By my sig iarare below. 1 hereby waive this requirement. I am the(check one)0 owner ❑owner's agent
t Owner/Agent
JSign re Telepbone No. PERMIT'FEE: $