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� • APPLICATION FOR PERM�T �0 PERFORM E�ECTRICAL WORK
�s � All work co be performed in u�urdancc with the Massachuse[[s Elearical Code,FPR-11
� = TOWN OF YARMOU7�1 coFFice use oN�v�
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' IMPORTANT
OWNER'SINSURANCEWAIVER:IamawarettiatttieLxer�aeedo�rrot �
F8@: $ �� �.�+
have die insurance coverege or iGs substantial equlvaleM as required �
byMassachusettsGeneraltaws,andthatmysignatureonthisperm�ap- pERMIT NO. �—OU'�L�
plication waives this requirement. Owner Agent
�swr..aa...>ro.0 Te1��• Date � 19
1b che Inspector oF Wires:The unde'ai'igned applies for a permic ro perform the electtical wnork�deuribed 6elrow ��/�����
I.ocadon(Saee�and Number) ,g � [� �� FY1 �/4S C FLC�-• C.J �• ��F�+'�"Pole�o. Z
Ownerbt Teoant M •
Owner s Address
Is dus permit in rnnjuncrion with a building permid . NO Y � No
B� U� � PumP v ��
Service ��`I Amps �� volts BY_ No of Me�ers f
i��� Ezis[ing C- � New 0 I� /� Increased, fro�m n ro
Nsture of�he Proposed Elearical Work W L � �GJ'LtQP /f�»'lS �.SC.N� il L./fil�[n XIEI�� ��'M�
PROPOSED FIXTURES IN DETAIL (See attached schedule, if necess )
Location of Room Oudets Sw. Plugs Fixc Location of Room Ou[ku Sw. Pluga Fixt.
No.of Sw.Ou[ Heat-T e
No.of Oudets Lt. � Oil �
t No.of Rec. ' Gey
;� No.of Mowrs H.P. Elecmic-KW Connetted Load
� No.of S' ns Trans. Hot Wazer-Motors and Size �.
`� ti� Sceam Mown and Size ��,
y1 Name kce nte Hoc Air Morors and Size ''
�1- Wa[er Heacec Name late ee Misc.
� Clothes D er Name lace nre �.
�' Totallvsd ..
Q Size of Main Enu�ance Sw '�
�V Size of S�. Conduc � � �
� [NSURANCE CO G :Pursuant ro�he requiremenu of Maxrachusetts General Iaws. �
V I have a t ili nsurnnm policy induding Completed Open�ioar Coverage m its substantisl eqwvaknt.YES NO ❑ I have submiaed velid proof oF seme m this �
� office. Yp o❑ fyou6avecheckedyE$,PleaceindiracerherypeofcoveragebycheckingcheapPcapriamb�. / .
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Supplemenrdinformariononfomu(urnishedby�heinsptkcwofwims,sha116emailedordeGveredbyd�eapplioncwidunfire(5)workingdaysFromtheda[edafsaid �
apPlicuion,ifrequired by the insM.imrof wires. �