BLDE-20-006263 ets Commonwealth of Official Use Only
Lft` ` Massachusetts Permit No. BLDE-20-006263
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 Electri 1 Code MEC),527 CMR 2.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:6/
City or Town of: YARMOUTH T eInspector of 1 <t +
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. ,i lip t„„
Location(Street&Number) 50 SKYLINE DR JUN `ate.` a
Owner or Tenant MAYNARD ANDREA Telephone No
Owner's Address 50 SKYLINE DR,WEST YARMOUTH, MA 02673 o 8,,, 20
' /fl
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check y riati'=telt---„,
/
Purpose of Building Utility Authorization No.
Existing Service 100 Amps 120/24( Volts Overhead 0 Undgrd 0 No.of rs
New Service 100 Amps Volts Overhead 0 Undgrd 0 No. ,,r
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: replaced 100 amp overhead service and moved elec • -•
pipe for of wire on back of building. replaced gfi and bubble cover on rear deck.
Completion of the following table may .a,, c fires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of O
Transformers No.of Luminaire Outlets No.of Hot Tubs Generators 4,SA
No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting 40
grnd. grnd. Battery Units ,
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 2 42/
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/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 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 Siens 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: 06/12/2020 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: WILLIAM C FLIGG
Licensee: William C Fligg Signature LIC.NO.: 12584
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 FREEMAN RD,YARMOUTH PORT MA 026752304 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