HomeMy WebLinkAboutBlde-19-007169 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-19-007159
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:6/20/2019
City or Town of: YARMOUTH To the Inspector of Wire
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 152 PAWKANNAWKUT DR
Owner or Tenant HICKEY DEAN J Telephone No.
Owner's Address HICKEY KIM E, 7 FIELDSTONE DR, SHREWSBURY, MA 01545
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 200 Amps 120 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: Partial rewire of water damaged areas
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
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting
grnd. grnd. Batter,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 0 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 Sins 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. 78 i'5 pi1Jn_ 569/J
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) `J C�
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: EAV SOLUTIONS
Licensee: JEFFREY S DEROUEN Signature LIC.NO.: 22206
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 110 Hedges Pond Road, Plymouth MA 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:$75.00
efrilet
-4J 4 g171 igt
C1L4t_ CV--31((/ fL�