blde-19-003547 0 Commonwealth of Official Use Only
Permit No. BLDE-19-003547
E Massachusetts
)1
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
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:12/11/2018
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) 15 NANTUCKET AVE (JI 7— C of 3 S
Owner or Tenant TELFORD MILDRED L Telephone No.
Owner's Address 15 NANTUCKET AVE,SOUTH YARMOUTH, MA 02664
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 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 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 20
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 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: 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: Bryant K Dundon
Licensee: Bryant K Dundon Signature LIC.NO.: 53109
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:67 TAURUS DR, MASHPEE MA 026493458 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
2, �/(9 � e.�. (1/1eir 9
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`� \ �J �om+noruusa ol///aacfts Offs ' Use Only
-"' Apartment C�( -3 1`�
�i 2 e / Permit No.
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- === Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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: /2 — //- / Y
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the pridersigned iv s no 'c of his or her intention to perform the electrical work described below.
Location (Street&Numbee�) 6 �� ,14., Ltr¢>It'- 4e' -
Owner or Tenant H+ Telephone No.
Owner's Address �/ < wI f GiCL�- f ../1 -e_..-
Is this permit in conjunctio with a building permit? Yes 0 No (Check Appropriate Box)
Purpose of Building
-_-- 5(deO/firil _ Utility uffiorizatioa_No."- ---- -- -
Existing Service 7./7.PJ Amps /}G/Z ye/Volts Overhead PEI. Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters
NNumber of Feeders and Ampacity 3
Location and Nature of Proposed Electrical Work: //t
� rlic_ /�rtr' Ef/
Ir
Completion of the fallowing table may be waived by the Inspector of Woes.
No.of Recessed Luminaires No.of Ceil.-Busy.(Paddle)Fags No.of Total
Transformers KVA _
No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' ,1
No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting -EJ-
=rnd. ornd. 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
Toial
No.of Ranges No. of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingMunicipal
KW
Low Q Connection 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No. No.of Devices or Equivalent
of No.of
Heaters ' Data Wiring: -
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 FVires.
Estimated Value of Electrical Work: /5 0 0 (When required by municipal policy.)
Work to Start: 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 overage 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 pal d enalties of p • ,that the information this a pl cation is true and complete.
FIRM NAME• LIC.NO.:_z
c^/
Licensee: t Signatur LIC.NO.:
(If applicable,ent r"exempt"in t e license numb r line.) us.TeL No.:
. Address: C-7 vl�t l r■r. L , °eGc4 Alt.Tel.No.: u�
j Per M.G.L.c. 147,s.57-6 security work requires Department of Public Safety"S"License: Lic.No.- 'l
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally
S required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner ❑owner's agent
Owner/Agent
Signature Telephone No. I PERMIT FEE: $