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��� Massachusetts PermitNo. BLDE-15-004265
�' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfo}med in acwrdance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT/N/NKOR TYPE ALL INFORHL9TIONJ Date:2/24/2015
CityorTownof: YARMOUTH Tothe/nspeciorofWires:
By this application the undersigned gives no�ce o �s or er mten on pe orm e e ecmc work descnbed below.
Location(Street&Number) 17 HOPE RD �
Owner or Tenant MICARI PETER Telephone No.
Owner's Address MICARI PATRICIA,22 BARBAR,4 RD, TOLLAND, CT 06084-3534
Is this permit in conjunctioo with a building permit7 Yes ❑ No ❑ (Check Appropriate �
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of M
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Loca6on aod Nature of Proposed Electrical Work: Winng for'septic pump and 818rtn
Camp[etian oj[he jollawing table may 6e waived by the lnspector oJWires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.oF Total
Transformers KVA
No.of Lumivaire Outlets No.of Hot Tubs Generators KVA
No.ot Luminaires Swimming Pool Ar�a e � I�od � No.of Emergency Lighting
Batte Units
No.of Receptacle Outlets No.of Oil Burners �FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Dehction and
Initiatin Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of W aste Disposers Heat Pump Number Toos KW No.of Self-Contained �
Totals: Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other.
Connection
No.otDryers Heating Appliances KW Security Systems:*
No.of Devices or E uivalent
No,of Water �, No.of No.of Data Wiring:
Heaters Si ns Ballasts No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.otDevices or E uivalent
OTHER:
Attach additiowl detoil f desired,or as required by!he/nspecior af Wires.
Es[ima[ed Value of Electrical Work (When requ'ved by municipal policyJ -
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the perfortnance of electrical work may issue unless the licensee
provides proof of IiabiliTy insurance including"completed operation"coverage or its substanrial equivalent.The undersigned certifies that such
coverage is in force,and has e�ibited proof of same m the permit issuing office.
CHECKONE:INSURANCE ❑ BOND ❑ OTHER ❑ (SpecifyJ �
I certify,under the pains and penalties oJperjury,that!he injarmation on this application is true and comp[ete
FIRM NAME: THOMAS M CRAFTS
Liceosee: THOMAS M CRAFTS Signature LIC.NO.: 31520
(!J'applicable,enter"exempP'in the[icense nvmber line.J Bus.Tel.No.:
Address: PO BOX 627,W HARWICH MA 02671 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,securiTy work requires Department of Public SafeTy"S"License:
OWNER'S INSURAVCE WAIVER:I am aware that the License does not have the liabiliry insurance coverage normally required by law.But
sig�ature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
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