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�. Commonwea t o
� ��� Massachusetts PermitNo. BLDE-1S005376
' BOARD OF FIRE PREVENTION REGULATIONS Occupancy agd Fee Checked
ev.1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
P.11 work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRlNT IN MKOR 7YPEALL lNFORMATlONJ Dat¢:5/4/2015 '
Clly O�TOWO�Of: YARMOUTH Ta the7nspectorojWires: O .-
By this application the undersigned gives no ce o �s or er m en on pe orm e ec ca work described below. "
Location(Street&Number) 16 SALT MARSH LN
Owner or Tenant GALVIN EDWARD J Telephone Na '�
Owner's Address C/O PETER GALVIN, 16 SALT MARSH LN,WEST YARMOUTH, MA 02673
Is this permit in conjuncHon with a budding permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Ufility Authorizafiou No.
Evsting Service Amps Volts Overhead ❑ Ondgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders aod Ampacity
Locafion aod Nature of Proposed Electrical Work: SeptiC pump 8nd 81artn
� � Campletion of the following table may be waived by the Inspector of Wires.
No.of Recessed Lumioaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transf rm KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above � In- � No.of Emergency Lightiug
md. rnd. Batte Units �
No.of Receptacle Outlets No.of Oii Burners FIRE ALARMS No.of Zones ��
No.of Switches No.of Gas Burners No.of De[ection and �
Inkiatin Dev�ces
� No.of Ranges No.of Air Coud. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �
To[als: DetectionlAlertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Muoicipal p Other:
Conoection
No.of Dryers Heating Appliances g�V Security Systems:*
No.of Devices or E uivalent �
No.of Water KW No.of No.of Data Wiring:
Heaters Si ns Ballasts No.of Devices or E uivalent
No.Aydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiriog:
No.of Devices or E uivalent
OTHER:
Armch pddi7ional demil if desired or os required 6y the Inspecfor of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completioa
INSURANCE CO VERAGE:Unless waived by the owner,no permit for the performance of e]ectrical work may issue unless the licensee
provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies thffi such
coverage is in force,and has e�ibited proof of same to the permit issuing office. ���
CHECK ONE:INSURANCE ❑ BOND ❑ O'fI-IER ❑ � (Specify:) � '
7 certify,urtder the parns and pena@ies of perjury,that the injormation on this application is bue and complete �,
FIRM NAME: DAVID W SILVA ���
Licensee: DAVID W SILVA Sigoature LIC.NO.: 20608
(ljapplicab/e,enier"ezemp!"rn the license numberline.J �� Bus.TeL No.: �
Address:55 THISTLE DR, CENTERVILLE MA 02632 Alk Tel.No.: '
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License:
OWNER'S INSURANCE WAIVER[am awa�e that the License does not have the liability insurance coverage normally required by law.But
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent. �
Owoer/Agent
Signature Telephone No. PERMIT FEE:$50.00
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M�r US 20�5
. HEALTH DEPT. .