HomeMy WebLinkAboutBLDE-22-004966 or
t�■ Commonwealth of Official Use Only
�'t l Massachusetts Permit No. BLDE-22-0 04966
BOA OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.l/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 City or Town of: YARMOUTH :3/8/2022
InspectorTo the
By this application the undersigned gives nonce o is or her intentino to perform t e e ectnca work described below. of Wires:
Location(Street&Number) 75 CURVE HILL RD
Owner or Tenant CANNING ROBERT J
Telephone No.
Owner's Address CANNING LAURIE J, 75 CURVE HILL ROAD, SOUTH YARMOUTH, MA 02664-2104
Is this permit in conjunction with a building permit?
Purpose of Building Yes 0 No 0 (Check Appropriate Box)
Existing Service 100 Utility Authorization No.
New Service Amps Volts Overhead 0 Undgrd 0 No.of Mete rs
Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: enerator installation w/5'trench
Completion of the following table maybe waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of
Ta firnes Total
K A
No.of Luminaire Outlets No.of Hot Tubs
Generators 1 KVA 18
No.of Luminaires SwimmingPool Above In-
:rnd. ❑ rnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets B•tt• i it
No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners
No.of Detection and
No.of Ranges 'tiati i v'c•s
No.of Air Cond. Total
No.of Self-Contained
No.of Waste Disposers Heat Pump Number Tons n No.of Alerting Devices
Total : KW
No.of Dishwashers Space/Area Heatingto fo i 1•rti vi •
Local 0 Municipal 0 Other:
No.of Dryers Heating Appliances l i ne t'•n
No.of Water KW Security Systems:*
H•at• s KW No n f No.of Ballasts Ni. 'f D•v' r E ival• t
Data Wiring:
No.Hydromassage Bathtubs k o. if D• i •s 1 , .iv•1•nt
No.of Motors Total HP Telecommunications Wiring:
OTHER: N I. o f D•v'c• or _1 _iva • t
Estimated Value Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: 0 of Electrical
022 (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
OTHER I certify,under the pains and penalties o perjury,u that the information on on this applications true and complete.
FIRM NAME: RANDALL C AGNEW p f
Licensee: Randall C Agnew
Signature Tel. NO.: 17492
(If applicable,enter"exempt"in the license number line.)
Address:381 OLD FALMOUTH RD, MARSTONS MILLS MA 026481555 Bus.Tel.No.:
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 bylaw.
signature below,I hereby waive this requirement.I am the(check one) But my
Owner/Agent 0owner ❑ owner's agent.
Signature
Telephone No.
t/c.7 5/'/(Z� PERMIT FEE:$75.00
C
1 S 6117/zz, -