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Commonwealth of Official Use Only
e Massachusetts Permit No. BLDE-19-001579
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.I/071
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:9/14/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 38 ALDEN RD
Owner or Tenant BLACKMAN ERIK Telephone No.
Owner's Address BLACKMAN KRISTIN, 12 ELMAR DR,FEEDING HILLS,MA 01030
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No. 2296290
Existing Service 100 Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Upgrade service.
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 Hot Tubs Generators KVA a
No.of Luminaires Swimming Pool Above ❑ In- ❑ 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
Initiatin¢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 O
No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
Connection 11 1
No.of Dryers Heating Appliances KW Security Systems:' ^
No.of Devices or Equivalent rn
No.of Water KW No.of No.of Data Wiring:
Heaters Sirs 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: 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 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: JOHN H BREWER
Licensee: John H Brewer Signature LIC.NO.: 14092
(If applicable,enter"exempt"in the license number line.) Bus.TeL No.:
Address:205 CEDAR ST,W BARNSTABLE MA 026681324 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,I 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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