HomeMy WebLinkAboutBLDE-22-004791 Commonwealth of
Massachusetts Official Use Only
*of. Permit No. BLDE-22-004791
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BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
(Rev.1/071
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:2/28/2022
City or Town of: YARMOUTH
To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 110 EVERGREEN ST
Owner or Tenant FALCONE RALPH A TRS Telephone No.
Owner's Address FALCONE ALICE C, 110 EVERGREEN STREET,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 Total
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets
No.of Hot Tubs Generators KVA
Above In- El No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. ❑ grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Detection and
No.of Switches No.of Gas Burners 1 Initiatine Devices
No.of Air Cond. Total No.of Alerting Devices
No.of Ranges Ton
No.of Waste Disposers
Heat Pump I Number I Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
al❑ Municipal
No.of Dishwashers Space/Area Heating KW Local Connection 0
Other:
Security Systems:*
No.of Dryers Heating Appliances KW No.of Devices or No.
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Siens No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total HP 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 LIC.NO.: 51981
Licensee: Robert E Bowdoin Signature
(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 my
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 I
0/ 5 IS1?
CesocarawardiL 41 amarkershil Official Use Only
-1 ' Pertnitlio. ---''252- L:024____
Occupancy soul Fee Checked
" - -, BOARD CF RRE PRBWION WGIAATIQIi3 Wen_Iffilj owe wow
...
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Al winktn he perfumed in accordance nigh the Massanhandis Ebacniai 0,de t. I='A 7-."-OAKUM
IPLEASE PRINT MINK OR MEAUDWORALfT1O1'9 Date 9 JCity or or Town of . V6 CrY101A-t-1, lb the , ,,,,,,,, of wires:
By this argamticatim andersi*ed gives Relict oflis Or her idesdul- nto-perfonu ihe-ansical landE deSalled WOW.
Location(Sheet&Number) 1 I (-) evcr ecy) -")--.
Onnerna-Tenant -fle/I p h rai Co ri ' Telephene-Ne.‘5 CV- il -5`11. ,
owner -Aefress -
is this permit la iraa4waerson with a banerarg perenV Yes 0 No El (Check Appreprivto Box)
lialpesp of Bralaug UAW Aidberhatiest Ns.
Existing Servan- Awls f Vohs Overhead 0 Iludgrd Et No.of Mena
New Serviee - Aar* - -i- Y °nestle:dip Ihidiged Ea- - No.of Mars _ =_
Naaaber of Feethas and AinpaeNy
Location andNattwo of-Proposed Electrical Worle W 1 rc 3a.e. tapo‘ i e(--
ComplethetofthefallowiegeableentoplawaneldbytkehevieeterttrWires.
Nu.el Tata
Pin afhteressed lag iinnair' es of faeg.-Basp.(radanc)Fans Trailsianneis KVA
.... _
No.of Luadnehe' Outlets No.of Hat Tubs Generators KVA
Abase 1---1 In- No.al Entergencir Laghting
ita.at' A3winallfaig Peel Igo& 1-1 ruid. El Battery UeNe
__________
Ne.et Reeepteek Outlets . No.of Oil Burners FIRE ALARMS Tweet Zones
)(0.Of Deb:than end
No.riSarlarker .No.of Gus Burners 1 indildw.- - Dvices- ,
Nadi amass No.d Air Owl. rem au et'Bakes
ant
•
No.of___stlrefesess Heat ruinp 1 Number IT ous IKW -No.ofFelf-Oltqahnd
Totrdzai 1)aeccocuidlelre Devices
No.efitislowashors Space/Area Beating KW 3.An1lj i,. ::7 DO
- - Nft:eorDayeas BearingAppRanees KW
- .
No.air Water No.of No.or llata Wain*
,
Beaters KW Toms Baena No.oflterkes or
-.. No.ildryumannageButhiadbs No.angers Total HP
_ . ...--- _ No.ofDraires or -,= .*- -
-0THER:
, w Aiteckorkliffonolistai fah*set trosnwee- dbytkehapeefortf Wires.
Estimated Wee ofEfechicad Work 6 0(-I• — (When TO:piled bY DIUdePal POTICY-)
Wad(lo Sint_ _ lasinetian as be ravened kt accoutocce with MC Rae IO.,and upon conviction-
INEXTBANCE COVERAGE:Unless waived by the mom im)perei tribe patron=ofeleehical Am*may issue unless
ibe licensee pnwides 1;mila-fill:ay rinswanceimIenscrompieled upersline coverage wits sthsbndill ewiitaket The
unders*fied eertiffics dud such cuseruge is lattice.and has=taxied Inunfersancin tha permit-issuing office. .
CHECK ONE: IlatillAWS Itt BOND 0 Mgt[I {specific)
I certify,ostler thepsik s tok I penalties tepesirtty,that&e hforowslion Wit thh oppfficegoa is Mega complete,
FIRSINAME:
_Ammo IMF . LIC.410.:
Liagesem-Pke-)ber-f--r Vat 0 in ffiguatore 41111-11P.- = - LIC...Noz5i fig i E
.,=—. - sie . .- mmurharfroviitv- , Bus.Td.Noz-fri q-(3(-.9-o ritt 7
liditstbkir rt6- wilea 4 coil 'Kei ilkithilioiti) irili eva. -i-Cs't AIL Tel.No.:-._
*Per M.OL.r...147,s.Silt security ma&=ries Drfortuatut ofPubric Safely"Sit Lions= Lie.No.
owNors HNC WAIVER: I an awl=dot theLicensee does not have thebabsT*insernWe coverage nomulity
=piled by law. By my*Ow below,1 horchy-waive' this requinanant. I ant ihe(cheek one)0 owner El ownees agent.
Owned**
Moisture Telephone Pio. • I PERmiltrag:$
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