HomeMy WebLinkAboutBLDE-21-000312 Commonwealth of Official Use Only
fiA Massachusetts
Permit No. BLDE-21-000312
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.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:71'I
City or Town of: YARMOUTH nspector o Yirwe-
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 7 SMITH RD
Owner or Tenant MACROBERTS RICHARD Telephone No. AC)C
Owner's Address CIO GANDERSON NORMA J, 5268 WETHERSFIELD RD,JAMESVILLE, NY 13078 C n
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Approp at: :ox) 4" / v
Purpose of Building Utility Authorization No. i/�(/ 0
Existing Service Amps Volts Overhead 0 Undgrd 0 No. f •ter "�.
New Service Amps Volts Overhead 0 Undgrd 0 N ogM,,•, / /
Br
Number of Feeders and Ampacity =,
Location and Nature of Proposed Electrical Work: wire bathroom,washer dryer in basement and added basement ligh ally ?i t
Completion of the following table a waived by the Inspe l if Wires.
No.of Recessed Luminaires No.of Ceil:Sus .(Paddle)Fans No.of Total
p Transf KVA
No.of Luminaire Outlets No.of Hot Tubs Gene 411 ,QPKVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Em * i
grnd. grnd. Battery Units #� O
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS N i P
No.of Switches No.of Gas Burners No.of Detection mug
440
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 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: ROBERT E BOWDOIN
Licensee: Robert E Bowdoin Signature LIC.NO.: 51981
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:502 PITCHERS WAY, HYANNIS MA 026012582 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
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