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Commonwealth of om���u�o��Y
.. ��� Massachusetts PermitNo. BLDE-15-004492
. BOARq OF FIRE PREVENTION REGULATIONS Occuparicy anf Fee Checked
ev.1/07
APPLICATION FOR PERMIT TO PERFORM ELE�TRICAL WORK
� All work to be perfonned in accordance with[he Massachusetts Electncal Code (MEC),527 CMR 12.00
� (PLEASE PRlNT/N INK OR TYPEALL fNFORMATlONJ Det¢:3/11/2015
� City o�TOwu O$ YARMOUTH 7'othelnspectorojWires:
� By this application the undersigned gives no ce o �s or er mten on o pe ortn e e work described below.
� LocsNon(Street&Number) 19 PAINE RD
Owner or Tenant COADY JAMES � Telephone No.
Owner's Address COADY ELIZABETH A, 19 PAINE RD, SOUTH YARMOUTH, MA 02664
Is t6is permit in conjuncfion with a building permit? Yes ❑ No ❑ (Check Appropriate Box) �
Purpose of Building Utility Authorization No.
Existiog Service Amps Volts Overhwd ❑ Undgrd ❑ No.of Mehrs
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Mehrs
Number of Feeders and Ampacity
Location sod Nature of Proposed Electrical Work: Wi2 replacement sep6c system
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lumioaire Outlets No.of Hot Tubs Generators KVA
No.of Lumioaires Swimming Pool Above � In- � No.of Emergency Lighting
rnd. rnd. Batte Units
No.of Receptacle Outlets No.of Oil Bumers FIRE AI.ARMS No.of Zones
No.of Switches No.of Gas Burners No.of DehMioo and
� Imtiatin Dev�ces
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �
Totsls: Detection/Akrtin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
Connecfion
No.of Dryers Heating Appliances �{�V Security Systems:* �
No. f D v'ces or E uivaknt
No.of Water My No.of No.of Data Wirmg:
Heste Si Ballasts No f Devices or E uivaknt
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devices or E uiva nt
01'HER:
AJlach additioml demi(if des'ved as as required by ihe Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: Inspection W 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 its substandal equivalent.The undersigned ce�es thffi such
coverage is in force,and has exhibited proof of same to the pertnit issuing otlice.
CHECKONE:INSURANCE ❑ BOND ❑ OTHER ❑ ' (SpecifyJ
!cer[ijy,under the pains and penakiu ojperjury,that the injormation on this app/ication is bue and comp[ete
FIRM NAME: THOMAS M CRAFTS �
Licensee: THOMAS M CRAFTS Signature LIC.NO.: 31520
Qjapplicable,enJes"exempP'in!he(icense number line.) ` Bus.Tel.No.:
Address: PO BOX 627,W HARWICH MA 02671 Ak.Tel.No.:
'Per M.G.L.c. 147,s.57-61,security work requires Deparbnent of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware thai the License does not have the liabiliry insurance coverage normalty required by law.But
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owcer's agent
Owoer/Ageot
Signature Telep600e No. PERMIT FEE:$50.00
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MAR 12 20i5
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