HomeMy WebLinkAboutBLDE-21-005416 *e—
Massachusetts ,
Commonwealth of Official Use Only
a Permit No. BLDE-21-005416
'
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 Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:3/22/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.Location(Street&Number) 19 CAPT PERCIVAL RD '77 4-2 i 2- �j
' J / 2-.3
Owner or Tenant Kelley Martin Telephone No.
Owner's Address 19 CAPT PERCIVAL RD,SOUTH YARMOUTH, MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement boiler.
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 Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 1 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/Alertinc 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: 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: $50.00
Ki2pt_ CO 1'7194 > Cnit t5, L/N
/c,. f l_ 0 a fQ/j/2%30.
um Only
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- �e .� Oc�yandFeeC :ed.. BOARD OF FIRE REGULATIONS :t�
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3leave
% APPLICATIONFOR PERMIT PERFORM ELECTRICALWORK
All vont to be perintfted in tortedonee oft FJer r�iode ..11-, ChM12.aa
1 ( � �DT BM i _' ' 'ALL � 1
�' +> i'
�r Gi i l -{ 1 To the , .,_•.:,, Wires:
By this application the niniguudovis*din digs tx Wideman to prism the.deadest wok deserted heir_
Lame=(Street 41
& ) I`i h erc y 2d
Owner er R Ke (lc i, (liar-1-in Taupe=No. 19U- -1a-3723
i Osaxer's Address _
Isidspermitfa�l.esesa�aiii4pu Yet 0 0 t - �
zi rumen of Walks - any Ailbodailiti No.
s t Veils °inbuiltED ud0 No.of Meters
. New Sem In Rips I Vans tfaabe.sd 0 Undgrd Q No.of Meters
Nazar of FeukasaulAspodir
Nature ofirropwil eerie-iViela 6-- Cu bc 1 lc'
v.--1
.? 'No.a€�ec ssedT— -. +ec No.e£Ci ■�.�laiijl�l� i
e,- SVA
=� No.of Oa®ets No.of Tubs XVA
!lieu lia- ait
,' No.>if >i9rd. Q smi. ❑ ieis
gnerseity won
-_ As.atiliciondi Odds No.ef01I Burners : f's:.ALARMS d Zones
Told .
a; ago.argongss No.s€A�#r Caad. of Doukas
!'3e; 3'PasieBipa�aons
Pass ' a �6V` i` a[
8 s pro.,.
No.of El Oiler
No. No.oi No.of . Widow
No. Haat= KW
$Ti sssge N O.ofMoto s d BP
Ne.orDeskestr
if-thst,E4 or rag .ad be.t&sli ers,¢'irtres.
Estimated Value of Etecaimi Woa:k (Wh tecinited by tranticipat policy.)
WC&10 Sim b be requested in toordlaus with MEC Ibis 10,gad i
iiPANCE antRAGE: Dolan waived by the oneer,no permit for the perfonaanoe of clectical woth.EnaY issue se2ecS
the licensee Rovileappeafefralaty immense including "covers wits substantial equivalent. Thu
telliasigned eettsTas line such eoaesage is in fie,and has extaited proof of same to the peimit issuing office.
CHECK ONE: INAIRANCE 0 BOND a OTHER. 0 ( )
cerft Ender its �pettiMas e on man s isms and comatose
FIRM NAM;
i LJC
froizaceabk.ewer".--eilweilvie 4 th4 license snaaltrer fine) Ail ' Bits.TAN=7 74,--5be--091,7
A TELNoevfle'KW..C.147,S.57-61, � of Pu "�Firms• Lie.
o�OWNER'S IMURANCE WAS i am aware that the Liaessee does Hat have
requirvi bY is% BY MY eaten Wow,I hereby wake this*quire:mem I sm the(cheek one eametreMelageouiti.es Y t.
- _ TMDhsea No. IPKRWTFEE:FEE:$ i
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