HomeMy WebLinkAboutBLDE-21-007031 Commonwealth of Official Use Only
/IA Massachusetts Permit No. BLDE-21-
007031
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)
City or Town of: YARMOUTH Date: spec21 To
In
By this application the undersigned gives no ice o is orher men ion o pe orm e e ec ica work described below r of Wires:
Location(Street&Number) 18 NORTH SANDYSIDE LN
Owner or Tenant LINK JUDITH A
Owner's Address 60 WITHERELL DR, SUDBURY, MA 01776 Telephone No.
Is this permit in conjunction with a building permit?
Purpose of Building Yes 0 No 0 (Check Appropriate Box)
Existing Service Utility Authorization No.
New Service Amps Volts Overhead ❑ Undgrd ❑ Nofo. Meters
Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Generator Installation W/trench
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
Transformers Total
No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA KVA 24
No.of Luminaires SwimmingPool Above In-
�rnd. ❑ �rnd. El No.of Emergency Lighting
No.of Receptacle Outlets Batte Units
No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners
No.of Detection and
No.of Ranges No.of Air Cond. Total Initiatin, Devices
No.of Waste Disposers HeatNumber
Pump No.of Alerting Devices
Totals: KW No.of Self-Contained
No.of Dishwashers Detection/Alertin, Devices
Space/Area Heating KW Local 0 Municipal
No.of Dryers Connection ❑ Other:
Heating Appliances KW Security Systems:*
No.of Water KW No.of No.of Devices or E i uivalent
Heaters No.of Data Wiring:
Ballasts No.of Devices or E i uivalent
No.Hydromassage Bathtubs
No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or E I uivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: 0 f 021 (When required by municipal policy.)
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
I certify,under the pains and penalties o OTHER 0 (Specify:)
FIRM NAME: fperlury,that the information on this application is true and complete.
RANDALL C AGNEW
Licensee: Randall C Agnew
Signature
(If applicable,enter"exempt"in the license e.)number lin LIC.NO.: 17492
Address:381 OLD FALMOUTH RD, MARSTONS MILLS MA 026481555 Alt. Tel. o.::
*Per M.G.L.M.G.L.C. 147,s.57-61,security work requires Department of Public Safety"S"License: Tel.No.:
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
) ❑ owner 0 owner's agent.
Signature
Telephone No.
PERMIT FEE:S75.00
12 — (&eLi - tot(` r?-( (L
94 (2/7101