HomeMy WebLinkAboutBLDE-19-001136 o'
Commonwealth of Official Use Only
1..1....*I Massachusetts Permit No. BLDE-19-001136
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical od MEC),527 CMR 1 0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:8 /2018 S' 2-7 l(6
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perlomr the electrical work described below.
Location(Street&Number) 83 WEBBERS PATH
Owner or Tenant NYHUIS KATHLEEN Telephone No.
Owner's Address 83 WEBBERS PATH,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install electrical wiring for first-floor laundry. Install GFI receptacle and
disconnect for dishwasher.Replace light above stairwell to basement.Move Move switches in hallway.Add GFI receptacle in
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Ilot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ElNo.of Emergency Lighting
grnd. gnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Watery No.of No.of Data Wiring:
Heaters Siens Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: 08/22/2018 Inspection to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: William C Fligg •
Licensee: William C Fligg Signature LIC.NO.: 21351
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 FREEMAN RD,YARMOUTH PORT MA 026752304 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License:
OWNER'S INSURANCE WAIVER:I am aware 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 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $75.00
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