HomeMy WebLinkAboutBLDE-21-000545 Commonwealth of Massachusetts Official Use Only
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Permit No. �--�2( -0.94S
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i --. Department of Fire Services
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BOARD OF FIRE PREVENTION REGULATIONS [ReOv.up9/07)cy and Fee Checked(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:
City or Town of: 414 41 B v rX To the Insp. t; , Wires:
By this application the undersigneQ gives notice of his or her intention to performthe electrical wor �a
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Location(Street&Number) 3Q0 �3 .5/Adhe _j�� I/q j alit` / /
Owner or Tenant le4/44 L / Telephone 4h
Owner's Address same
Is this permit in conjunction with a building permit? Yes ❑ No /(Check Ap k 'lam;t, r /
Purpose of Building Utility Authorization N . 0 T
Existing Service /60 Amps /Z0 iy0 Volts Overhead ❑ Undgrd / 1 /
New Service /B 0 Amps /�0 /�/�7 Volts Overhead `
❑ Undgrd [L]� No.o Meters
Number of Feeders and Ampacity r2_ fedi /AO 4.9/S 0 Z ,I.A111- 8'3 7
Location and Nature of Proposed Electrical Work: jiletd 0,44m04' sav�G c
Completion of the following table may be waived by the Inspector of W res. at
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans
4,i
. A
; o KVANo.of Luminaire Outlets No.of Hot Tubs e�4., O KVA
No.of Luminaires SwimmingPool Above In- No4, _,:. ,4,. i ,
grnd. ❑ grnd. Batte .4
A.
No.of Receptacle Outlets No.of Oil Burners FIRE AL. 't� .
7 fnik.
No.of Switches No.of Gas Burners No.of io
Initiating De
Totallo.of Ranges No.of Air Cond. Tons No.of Alerting Devic
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: 'W" ..TI
" ". Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Munal
Connection 0 Other
No.of Dryers Heating Appliances KW 1.SecuritySystems:*
No.of Water No.of Devices or Equivalent
No.of No.of
Heaters KW Signs Ballasts DataNo.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: 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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER ❑ (Specify:) Merchants Insurance
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: R&S LaFleur,LLC LIC.NO.: 16814A
Licensee:Raymond E.LaFleur Signature LIC.NO.: 15675E
(ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: 50$-775-6814
Address: 45 Plant Rd; Unit# 101;Hyannis,MA 02601 Alt.Tel.
*Security System Contractor License required for this work;if applicable,enter the license number here:No.: 508-775-6838
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner
Owner/Agent ❑owner's agent.
Signature Telephone No. PERMIT FEE: $ — I