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HomeMy WebLinkAboutBLDE-21-000544 1 Commonwealth of Massachusetts Official Use Only rtfLA Department of Fire Services Permit No. ��-1 - ©s u Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/07) (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 INF7L4TION) Date: City or Town of: /1/./Nl1 BJ ff77 To the Inspector # ' ' es: By this application the undersigne gives notice of his or her intention to perfo the electrical • . •esc '.-d .- •w Location(Street&Number) .302 3,.,4it,y/ii L ai40-Z /J r• Owner or Tenant (� .P ,ti Telepho N N . I P Owner's Address sameC 0 Is this permit in conjunction with a building permit? Yes ❑ No (Che' A i . i i nate Purpose of Building o !Utility Authori r • o. Otirr, Existing Service/60 420/1V0Amps ' O Volts Overhead / B ❑ Undgrd No. ' rs- Newer 1Ce /6 0 Amps /211/NO Volts Overhead❑ Undgrd 2. No.of Meters Number of Feeders and Ampacity reeks /BQ 2445 2 Ai_ 10-ztar3f Location and Nature of Proposed Electrical Work: 4/ ,) udd SA,A.Jiz.e_ 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 Gene • 1 rs KVA No.of Luminaires Swimming Pool Above ❑ In- o No. I.ency Lighting grnd. grnd. L: 1i,, ) No.of Receptacle Outlets No.of Oil Burners �� `fe "1��.,��,',r'• 1 o of Zones No.of Switches No.of Gas Burners y' er, i� i' ..i., , 0 •2119IP No.of Ranges No.of Air Cond. Total No.of e /4c:No.of Waste Disposers Heat Pump Number, Tons KW 'No.of Self •M...Totals. � � Detection/Aler :�,i . ;;- No.of Dishwashers Space/Area Heating KW Local 0 Munnnectionicip.� n Co " r44,,er No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: 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: 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 ❑ 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 (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: 50$-775-6814 Address: 45 Plant Rd; Unit# 101;Hyannis,MA 02601 *Security System Contractor License required for this work;if applicable,enter the license num er here:No.:508-775-038 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner Owner/Agent ❑owner's agent. Signature Telephone No. I PERMIT FEE:$ — I