HomeMy WebLinkAboutBLDE-19-001236 nor r
Commonwealth of OffrcialUse Only
tee Massachusetts PennitNo. BLDE-19-001236
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.1/07j
APPLICATION FOR PERMIT TO PERFORM ELECTRI : L WORK
All work to be performed in accordance with the Massachusetts Ectriical Code (ME9e527 CMR 2R E
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:8297261: E D
City or Town of: YARMOUTH eTheinsptt'tor of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 77 SILVER LEAF LN SEP 14 2018
Owner or Tenant HORGAN MURIEL E Telephone No. R
Owner's Address C/0 GLOVER WILLIAM R III, 1555 ORLEANS RD, HARWICH,MA 02645 Ay
UILOit.k utas f�—
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate :ox
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters
New Service Amps Volts Overhead 0 Undgrd El No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring for two outdoor condensers.Wiring for Mini Split heads.Wiring for air
handler in basement.
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 i
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- o No.of Emergency Lighting
grnd. grnd. 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/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:"
No.of Devices or Enuivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTIIER:
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: 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 0 BOND 0 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"S"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,l hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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