HomeMy WebLinkAboutBLDE-21-003258 ,,10. Official Use Only
e,� ommonwealth of
' Permit No. BLDE-21-003258
%,37 Massachusetts
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
APPLICATION FOR PERMIT TO PERFORM ELECT4IC2*L WORK
All work to be performed in accordance with the Massachusetts Electrical Code (M>4c527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:8/24/2020-
City or Town of: YARMOUTH To 10 Ispector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work,steisiribed below.
Location(Street&Number) 23 MAYFLOWER LN
Owner or Tenant MCCABE JOHN J Telephone No. A 6,
Owner's Address MCCABE MARY ROSE, 123 BALCH STREET, PAWTUCKET, RI 02861
Is this permit in conjunction with a building permit? Yes 0 No El (Check App ri• •t' i,x O es'd /
Purpose of Building Utility Authorization No. �/�
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of M• r 4 h A
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
'Number of Feeders and Ampacity O
400 Location and Nature of Proposed Electrical Work: rough and final-4 season room
Completion of the following table may be waived by the Ins, ,�, Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tot
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Li l• g
grnd. grnd. Battery Units ankt
No.of Receptacle Outlets No.of Oil Burners FIRE ALARM N t of Zsitres 0
No.of Switches No.of Gas Burners No.of Detection . • s '51G i(N�.
Initiating Devices \ . 4.
No.of Ranges No.of Air Cond. TotaTonal No.of Alerting Devi ., .Oi O_ ��
No.of Waste Disposers Heat Pump Number Tons KW' No.of Self-Contained 'O �If
Totals: Detection/Alerting Devic \
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal > O ,
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 Signs 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: Christopher D Kelsey 6e,(d- 6e9- E824,
Licensee: Christopher D Kelsey Signature LIC.NO.: 52172
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:203 ROBINSON AVE,ATTLEBORO MA 027036820 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 NNoo. PERMIT FEE: $75.00
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