HomeMy WebLinkAboutElectrical Permit ��
Commonwealth of Official Use Only
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Massachusetts PermitNo. BLDE-15-003757
"— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked "
Rev.]/07]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINTlN/NK OR TYPE ALL/NFORMATlON) Date:1/13/2015
City or Town of: YARMOUTH Ta fhe lnspecior ojWires:
By ihis application the undersigned gives no me o �s or er mtennon to pe orm t e e ectrica work described below.
Location(Street&Numbery 17 SHORE SIDE DR �
Owner or Tenant PARMENTER HENRIETTA D LIFE EST Telephone No.
Owner's Address 17 SHORE SIDE DR, SO YARMOUTH, MA 02664
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate
Purpose of Building Utility Authorization No.
Ezisting Service Amps Volts Overhead ❑ Dndgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.ofMeters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wi�e septic pump 8nd alartn
Completion of the fo!lowing table may be waived bylhe Inspectar ojWires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA �
No.of Luminaires Swimming Pool ��a e ❑ �n�d ❑ No.otEmergency Lighting
Batte Linits
No.of Receptacie Outlets - No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detecfion and
� InitiaHn Devices
No.of Ranges No.of Air Cood. Total No.otAlerting Devices
Tons
No.of Waste Disposers � Heat Pump Number Tons KW No.of Se1LContained �
Totals: Detection/Alertin Devices
No.oF Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
ConnecNon
No.of Dryers Heating Appliances KW Security Sys[ems:*
No.of Devic or E uivalent
� No.of Water Kµ, No.of No.of Data Wiring:
Heaters Si ns Baliasts No.of Devices or E uivalent �
No.Hydromassage Bathtubs No.otMotors 1 Total HP Telecommunications Wiriog:
N ofDevices r uivalent
OTHER: •
AlJoch additional demil ijdesired,or as requrred by thelnspeclar of Wires.
Estimated Value of Elechical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 1Q and upon complerioa
INSDRANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee �
provides pmof of liability insurance including"completed operation"wverage or its substantial equivalent.The undersigned cert�es thaz such
wverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTI-IER ❑ (Specify:)
I ceRify,under the pains and pena[ties ojperjury,thal the injormation on this application is lrue and comp[e1e
FIRM NAME: LAWRENCE R BROWN �
Liceusee: LAVN2ENCE R BROWN Signature LIC.NO.: 30708 l
pfaPP/icable.enter"exempt"rn the ficense numberline.J Bus.Tel.No.:
Address:30 LIMERICK COURT, CENTERVILLE MA 02632 Alt Tel.No.:
'Per M.G.L.c. 147,s.57-61,securiry work requires Deparhnent of Public Safery"S"[,icense:
OWNER'S INSURANCE WAIVER:I am aware that the License does not hwe[he liabiliry insurance coverage normally required by law.But �
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent �
Signature Telephone No. PERMI :$80.00
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JAN 14 2p15
HEALTH DEPT.