BLDE-18-005087 `or Commonwealth of Official Use Only
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r.,1'► Massachusetts Permit No. BLDE-18-005087
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
f Rev.l/07)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.000 Q
(PLEA SE PRINT ININK OR TYPE ALL INFORMATIOM Datr:4/9/2G46 C 3 1(\ I S
City or Town of: YARMOUTH TO11e Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. n ���.0 0Location(Street&Number) 32 FLINTLOCK WAY (/.�n''/�/'M_
Owner or Tenant VIVIAN AUDREY TR Teleph No.
Owner's Address A M VIVIAN REALTY TRUST,32 FLINTLOCK WAY,YARMOUTH PORT,MA 02675-1107
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 100 Amps 120240 Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: one inspection
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 8 No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No,of Emergency Lighting
grnd. r- No.
Battery Units
No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 2 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 Equivalent
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
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: 03/09/2018 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 0 BOND 0 OTHER 0 (Specify:) �YIf.P�Upp 20491
I certify,under the pains and penalties of perjury,that the information on this application is true and complete. i , GIo(( l
FIRM NAME: Matthew P Logan
Licensee: Matthew P Logan Signature LIC.NO.: 12162
(If applicable,enter"exempt'in the license number line.) Bus.Tel.No.:
Address:303 SANDWICH ST,PLYMOUTH MA 023606503 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. I PERMIT FEE: $50.00
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