HomeMy WebLinkAboutBLDE-21-000431 Commonwealth a/Mamachujstj1 Official Use Only
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` 2 � `�. Permit No.
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BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 INFORMATION) Date:07/23/2020
City or Town of: South Yarmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the ee trical work described below.
Location(Street&Number)53 Nightingale Drive
Owner or Tenant Stuart Maynard
Owner's Address 868 Tail Oak Road-Naples, FL 34113 Telephone No.
Is this permit in conjunction with a building permit? Yes ❑ No
® (Check Appropriate Box)
Purpose of Building
Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd�' ❑ No.of Meters
New Service Amps / Volts Overhead❑
Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacing Furnace and Adding Air Conditioning
Completion of the following.table may be waived by the Inspector of Wires.
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No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of otal
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs
Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
grad. grad. ❑ 'Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners 1 No.of Detection and
No.of Ran es Total Initiating Devices
g No.of Air Cond. Tons 2 No.of Alerting Devices
(� t No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained '
J Totals: "'` '""- "' Detection/Alertin. Devices
No.of Dishwashers Space/Area Heating KW "cal
�❑ Municipal
No.of Dryers Connection ❑ Other
ry Heating Appliances KW Security Systems:*
No.of Water KW No.of No.of Devices or Equivalent
Heaters No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 1500.00
Work to Start:08/13/2020 (When required by municipal policy.)
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:)
I certify,under the pains and penalties o e ury'that the information on this application is true and complete.
Coastal Mechanical
FIRM NAME: p ' Pp
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Licensee: David Balfour LIC.NO.;22363-A
(If applicable,enter "exempt"in the license number line) Signature l �� _ LIC.NO.:22363-A
Address: 21 L Fruean Ave-South Yarmouth MA 02664 Bus.Tel.No.:5°8 737 etas
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Mt.Lic TeL
No. tst-seao
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability
required by law. By my signature below,I hereby waive this requirement. I am the(check on owner
El coverage normally
Owner/Agent ❑owner's •vent.
Signature Telephone No.
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PERMIT FEE:$ I� —
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