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Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-19-001178
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.l/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:8/28/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below.
Location(Street&Number) 73 CROWES PURCHASE
Owner or Tenant PATTON DELBERT E TRS Telephone No.
Owner's Address PATTON MARTHA,73 CROWES PURCHASE,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ 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 generator.
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 1 KVA 11
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
Initiating Devices
No.of Ranges No,of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained
Totals: Detection/Alerting 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 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: 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: Randall C Agnew
Licensee: Randall C Agnew Signature LIC.NO.: 17492
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:381 OLD FALMOUTH RD, MARSTONS MILLS MA 026481555 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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i' BOARD OF FIRE PREVENTION REGULATIONS 44;0.0 [Rev. (leave blank)
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:
City or Town of: Yarmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)73 Crowe's Purchase Road
Owner or Tenant Delbert Patton Telephone No. 508-775-8235
Owner's Address 73 Crowe's Purchase Road
Is this permit in conjunction with a building permit? Yes ❑ No ❑X (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 100 Amps 120 /240 Volts Overhead ® Undgrd❑ No.of Meters 1
New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: GENERATOR INSTALLATION
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
Transformers KVA KVA
No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 11
No.of Luminaires Swimming Pool Above ❑ In- 0 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 - —11'o,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/AlertintDevices
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 WaterKW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total IIP Telecommunications Whin :
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $3000.00 (When required by municipal policy.)
Work to Start:11/5/18 Inspections 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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: RCA Electrical Contractors Inc. /e?- LIC.NO.:17492A
Licensee: Randall C.Agnew Signature /7/, - /��7 �/// 1C,NO.:
(Ifapplicable,enter "exempt"in the license number line.) C• /SR I.No..508-428-0449 _
Address: 381 Old Falmouth Road, Unit 13, Marstons Mills, MA 02648 Alt.Tel.No.:508-648-6766
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety'S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent.
Owner/AgentPERMIT FEE: $
SignatureturaTelephone No.