HomeMy WebLinkAboutBLDE-21-000944 kt1),
Commonwealth of Only
Official Use
'. Massachusetts Permit No. BLDE-21-000944
Or 101\`"".0 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:8/24/2020
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 electncal work described below.
Location(Street&Number) 13 DIANE AVE
Owner or Tenant JANEK ROBERT J
Owner's Address JANEK ELIZABETH A, 13 DIANE AVE,SOUTH YARMOUTH, MA 02664 Telephone No.
Is this permit in conjunction with a building permit? Yes ❑ No ❑
(Check Apr gate Box)
Purpose of Building Utility Authorization No. ® //
Existing Service Amps Volts Overhead 0 Undgrd ❑ 440.•P
New Service Amps Volts Overhead CI Undgrd 0 r;®
Number of Feeders and Ampacity A/
�j {..
Location and Nature of Proposed Electrical Work: Generator Installation with 5'trench v4)8 Pi
Completion of the following table may be wa .,,l' ,y •ctor of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators 1
KVA 16
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal
Connection 0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of WaterNo.of Devices or Equivalent
Heaters KW No.of No.of Data Wiring:
Signs Ballasts No.of Devics 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:
(When required by municipal policy.)
Work to start: 09/17/2020 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: RANDALL C AGNEW
Licensee: Randall C Agnew Signature
LIC(If applicable,enter"exempt"in the license number line.) Bus Tel. NO.: 17492
Address:381 OLD FALMOUTH RD, MARSTONS MILLS MA 026481555 Alt. Tel.No.:::
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.
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.
_....-1 PERMIT FEE:$75.00