HomeMy WebLinkAboutElectrical Permit �
Commonwealth of off�;a�u�oa�Y
� Massachusetts PertnitNo. BLDE-15-005609
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
ev.1/07 '
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMIL 12.00
(PLEASE PRINT IN INKOR 7YPEALL INFORMATIONJ D3[¢:5/13/2015 �
City or Town of: YARMOUTH To the Inspectar o,rWires:
By this application tAe undersigned gives not�ce o �s or er m n on pe ortn e e ec �ca work described below.
Location(Street&Number) 173 PINE GROVE RD
Owner or Tenant ADOLPH ALAN TRS Telephone No.
Owner's Address ADOLPH JOAN ELLEN TRS, 7 BUCKMAN DR, LEXINGTON, MA 02173
Is this permit in conjuncNon with a building permit? Yes ❑ No ❑ (Check Appropriate Box) �-.
Purpose of Building Utility Authorization No.
Existing Service 100 Amps 120-24( Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Eiectrical Work: wire septic pump&alamt(508-221-7763) �
Compledon of the jollowing tab[e may be waived by the Inspector ojWires.
No.otRecessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transf rmers KVA
No.of Luminaire Outlets No.otHot Tubs Genenrors KVA
No.otLumioaires Swimming Pool Above � In- p No.of Emergency Lighfiog
rnd. rnd. Batte nits
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zooes
No.of Switches No.of Gas Burners No.of Detection and
Im� tin Dev�ces
No.of Ranges No.otAir Cood. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Nurober Tms KW No.of Self-Contained
Totals: Detection/Aier[in Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
Connection
No.of Dryers Heafing Appliances � �y Security Syshms:*
No.of nevices or E uivaleot
No.of Water �, No.of No.of Data W'ving:
Heahrs i ns Ballasts No.of Devices or E iv 1 ot
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunintions Wiring:
No.of Devic r E uivaient
OTHER:
Atmch additional demi[ijdesired,or ar required by the Inspecror ojWires.
Estimated Value of Electrical Work: (V✓hen required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 1Q and upon completion.
INSURANCE COVERAGE:Unless waived by the owney no percnit for the performance of electrical work may issue unless the licensee
provides proof of liabiliry insurance including"completed operation"coverage or its substanfial equivalent.71�e undersigned certifies that such
coverage is in force,and has e�ibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTT-IER ❑ (Specify:)
(certijy,under the pains and penaUies of perjury,that the information on thrs app[ication rs true and comp[de �
FIRM NAME: LAWRENCE R BROWN '
Licensee: LAWRENCE R BROWN Signature LIC.NO.: 30708
(11�aPPlicable,enter"exempP'in ihe license rtumberline.) Bus.Tel.No.:
Address:30 LIMERICK COURT,CENTERVILLE MA 02632 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,securiry work requires Departrnent of Public Safety"S"License:
O WNER'S INSIJRANCE WAIVER:I am aware that the License does not have the liabiliry insurance coverage normalty required by law.But
signature below,I hereby waive this requiremenk I am ffie(check one) ❑ owner ❑ owner s agent.
Owner/Agent
Signature Telep6one No. PERMIT FEE: $50.00
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