HomeMy WebLinkAboutElectrical Permitf
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��� Massachuse pe��tt o. BLDE-15-004968
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� BOARD OF FIRE PREVENTION RE ULATIONS . OcF up cy and Fee Checked
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APPLICATION FOR PE PERFORM ELECTRICAL WORK
All work to be perfortned in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINTININKOR TYPEALL/NFORMAT/ONJ Det¢:4/10/2015
City 01'ToWu Of: YARMOUTH TothelnspectorojWires:
By this applicazion the undersigned gives no ce o �s or er m n�on o pe ortn e e u work descnbed below. �
Locafion(Street&Number) 11 FILLMORE RD
Owner or Tenant MEGA GROUP RLTY TRUST Telep6one No.
Owner's Address NETTO EMILIO C TR, P O BOX 2388, HYANNIS, MA 02601-7388
Is this permit in conjuncfion with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Ufility Authorizatioo No.
Exis[ing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Naturc of Proposed Elec[rical Work: SeptiC wifing
Completron ojthe jo[lowing table may be waived by the/nspector oJWires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Tran f rmers KVA
No.of Luminaire Outlets No.of Hot Tubs Geoerators KVA
� No.of Luminaires Swimmiog Pool Aroa e � I'nd � No.of Emergency Lighting
Batte Units
No.of Receptacle Outlets No.of Oil Burners FIRE AI,ARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Ini ' tin Devices
No.of Ranges No.of Air Cond. TO�a� No.of Alerting Devices
Tons
No.o[WasteDisposers AeatPump Number Tous KW No.ofSel[-Cootained �
Totals: DetectionlAlertin Devices
No.of Dis6washers Space/Area Heafing KW LO�� � Connecfio�n � Other:
No.of Dryers Heating Appliances �' No.0 f Devices or E uivalent
No.of Water KW No.of No.of Dats Wiring:
Aeaters i s Ballasts No.of Devices or E uivalent
No.Hydromassage Bathtubs No.of Motors 1 Totai HP Telecommuoications Wiring:
No.of Devices or E uiv leot
OTHER:
Atmch odditioml demrl if desired or as required by!he Inspecmr of Wires.
Estimated Value of Electrical Work: (When required by municipa]policy.)
Work to start: Inspecfion to be requested in accordance with MEC Rule iQ and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the perfoanance of electrical work may issue unless the licensee
provides proof of liabiliry insurance including"wmpleted operatiod'coverage or its substantial equivalent The undersigneA certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECKONE:INSURANCE ❑ BOND ❑ OTHER ❑ � (Specify:)
I cerlify,under the pains and penaUiu ojperjury,that the injormation on this app[icatlon is hue and comp[de
FIRM NnME: DBA DREW ELECTRIC
Liceosee: ERIC W DREW Signature LIC.NO.: 13118
(Ifapplicable.enter'exempY'in 1he license num6er[ine.J - Bus.Tel.No.:
Address: 103A MIDTECH DR,W YARMOUTH MA 02673 � Alt.Tel.No.:
'Per M.G.L.c. 147,s.57-61,securiry work requires Departrnent of Public SafeTy"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the 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. PERM/T FEE:$50.00
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