HomeMy WebLinkAboutBLDE-21-006264 0' Commonwealth of Official Use Only
f� Massachusetts Permit No. BLDE-21-006264
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),
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of: YARMOUTH Date: Inspector To the 021
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. of Wires:
Location(Street&Number) 115 SOUTH ST
Owner or Tenant MOYNIHAN JOHN F
Owner's Address MOYNIHAN JOANNE, 35 MINERAL SPRING AVE, LUDLOW, MA 01056 Telephone No.
Is this permit in conjunction with a building permit?
Purpose of Building Yes 0 No 0 (Check Appropriate Box)
Existing Service Am s Utility Authorization No.
p Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts
Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters
Location and Nature of Proposed Electrical Work: Generator installation w/40'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 22
No.of Luminaires SwimmingPool Above In_
grnd. ❑ grnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets Battery Units
No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
No.of Ranges Initiating Devices
No.of Air Cond. Total
Tons No.of Alerting Devices
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 HeatingKW
Local 0 Municipal 0 Other:
No.of Dryers Connection
Heating Appliances KW Security Systems:*
No.of Water KW No.of No.of Devices or Equivalent
Heaters Signs No.of Data Wiring:
Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: 06/04/2021 (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
I certify,under the pains andpenalties o (Specify:)
fperjury,that the information on this application is true and complete.
FIRM NAME: RANDALL C AGNEW
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.lt. 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.
PERMIT FEE:$75.00
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