HomeMy WebLinkAboutBLDE-22-006182 inCommonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-006182
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
1/07
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 WORK
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
Date City or Town of: YARMOUTH e 2022
To Inspecto
By this application the undersigned gives notice o is or er intention to pe orm the electnca work described below.r of Wires:
Location(Street&Number) 50 CARRIAGE LN
Owner or Tenant MACHNIK CRAIG T
Owner's Address MACHNIK TRACEY A, 50 CARRIAGE LN, YARMOUTH PORT, MA 026 5elephone 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 ❑
Amps Volts g No.of Meters
Number of Feeders and Ampacity Overhead ❑ Undgrd 0 No.of Meters
Location and Nature of Proposed Electrical Work: minis lit installation
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
No.of Luminaire OutletsTran farmers Total
No.of Hot Tubs K A
Generators KVA
No.of Luminaires SwimmingPool Above In-
rnd. ❑ :rnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets Batt•r Unit
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. 1 Total 2.5 I iti,tin a Devic•s
No.of Waste Disposers Number Tonso
No.of Alerting Devices
Heat Pump
Tit. s: KW No.of Self-Contained
No.of Dishwashers Det•cti r n Al•rfn. Devi •
Space/Area Heating KW
Local 0 Municipal 0 Other:
No.of Dryers Heating Appliances onne t'on
KW Security Systems:*
No.of Water KW No.of No.of Devic•s or E i ui ale t
Heat rNo.of Ballasts Data Wiring:
i.ns
No.Hydromassage Bathtubs N i.of D•vi e or E s ival•nt
No.of Motors Total HP Telecommunications Wiring:
OTHER: N 0.of Devi •s or I ivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: 07/05/2022 (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 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
(If applicable,enter"exempt'in the license number line.)
LIC.NO.: 17492
Address:381 OLD FALMOUTH RD, MARSTONS MILLS MA 026481555 Alt.Tel.No.:
Bus.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 my
signature below,I hereby waive this requirement.I am the(check one
) 0 owner 0 owner's agent.
Signature
Telephone No.
PTC-3 7/i�r�( PERMIT FEE:$50.00
a �G32s 4)