HomeMy WebLinkAboutBLDE-20-005738 or NI.
Commonwealth of Official Use Only
E ',► ', Massachusetts Permit No. BLDE-20-005738
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
APPLICATION FOR PERMIT TO PERFORM ELECTRIC• L WORK
All work to be performed in accordance with the Massachusetts Electric Code EC),527 CMR 1 .09.„.
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:5 20
City or Town of: YARMOUTH To e Inspe r of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 100,
Location(Street&Number) 12 HEMLOCK PATH rOwner or Tenant MCMULLEN MARY TR Telephone No 11 (JOwner's Address MARY MCMULLEN IRR TRUST, 327 DEAN ST, NORWOOD,MA 02062 el'‘tit/A
il�o,� 2020
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appro. • Bo o.'..
Purpose of Building Utility Authorization No. of,'T
Existing Service 100 Amps 240 Volts Overhead 0 Undgrd 0 No o 0'4 kill4 �"
New Service 100 Amps Volts Overhead 0 Undgrd 0 of M
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacing 100 amp service with new 100 amp service. Ow
Completion of the followingtable may be �
ns t r es.
No.of Recessed Luminaires No.of Ceil:Sus .(Paddle Fans No.of . .l
p ) Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators - II' 40
Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Unit y g g 7�//
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones `` ((gyp f,
No.of Switches No.of r.-��a--- ' No.of Detection and S�
Initiating Devices
No.of Ranges No.of? No.of Alerting Devices
No.of Waste Disposers —
Heat Pu V No.of Self-Contained
Totals: Detection/Alerting Devices _
No.of Dishwashers Space/A Local 0 Municipal 0 Other:
_
Connection
No.of Dryers Heating Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of Data Wiring:
Heaters Signs No.of Devices or Equivalent ,
No.Hydromassage Bathtubs No.of Mi _.__, 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: WILLIAM J PERRY
Licensee: William J Perry Signature LIC.NO.: 20532
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 15 Hancock St, Marshfield MA 020506516 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