HomeMy WebLinkAboutElectrical Permit � Commonwealth of o�;��a�ose o��Y
��� Massach --° � :v��j� ermitNo. BLDE-15-005926
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�^' BOARD OF FIRE PREVENTI N RE�'i�WL�T�()I�I,S 5 Occupancy$nd Fee Checked
JIJIV LU I ev.1/07
APPLICATION FOR �_T��Ot�D ORM ELECTRICAL WORK
All work to be performed in lectrical Code (MEC),527 CMR ly�\
� (PLEASE PRlNT/N INKOR TYPE ALL MFORMAT/ON) DeY¢:6/1/2015 (�� �
City OI'TOwn 01: YARMOUTH 7'a the IncpectorojWires: �
By Ihis applicazion the undersigned gives no�ce o rs or er mtentwn o pe orm t e e ectnc work described below.
Locatiou(Street&Number) 31 AARONS WAY
OwnerorTeoant GLADSTONELTDPARTNERSHIP TelephoneNo.
Owner's Address 297 NORTH ST, HYANNIS, MA 02601
Is this permit in conjuuction with e building permit? Yes ❑ No ❑ (Check Appropriate Box) �
Purpose of Building Utility Authorization No.
Ezisting Service Amps Volts Over6ead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number otFeeders and Ampacity
Location and Nature of Proposed Electrical Work: S2ptic system wiring.
Campletion af the fo![owing tab[e may be waived by the/nspector ojWires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.o£ Total
Trsnsformere KVA
No.of Luminaire OuHets No.of Hot Tubs Genentors KVA
No.of Luminaires Swimming Pool '�ma e ❑ 1°�,�a ❑ No.of Emergency Lighting
Batte nits
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.oF Switches No.of Gas Burners No.of Detection and �
Initiatin D vices
No.of Ranges No.of Air Cood. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained �
Totals: Detcetion/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Muuicipal p Ot6er:
Connection
No.of Dryers Heafing Appliances KW Noc of Devices or�E uivalent
No.of Water �, No.of No.of Data Wiring:
Aeaters Si n Ballasts No.of Devices or uival nt
No.Aydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach oddifional det¢i!tjdesired or¢t required by the Inspet�ar of Wires.
Estimated Value of Electrical Work (When required 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 pecmit for the perfortnance of electrical work may issue unless the licensee
provides proof of liabiliry insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such
coverage is in force,and has e�ibited proof of same to the permit issuing office.
� CHECK ONE:INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
7 certify,under the pains and pena(ties ojperjury,that the injnrmation on this application is lrue and complde � �
FIRM NAME: BAYSIDE ELECTRICAL CONTRACTORS INC
Licensee: ARTHUR P DOHERIY Signature LIC.NO.: 17197
pjapplicab[e,enter"exempY'in!he lirense number line.J Bus.TeL No.:
Address:372 YARMOUTH RD, HYANNIS MA 02601 Alt.Tel.No.:
'Per M.G.L.c. 147,s.57-61,securiry work requires Departrnent of Public Safery"S"License:
� . OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liabiliry insurance coverage notmally required by law.But
signature below,I hereby waive this requirement I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telep6one No. PERM]T FEE: $80.00
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