HomeMy WebLinkAboutBLDE-22-002048 Commonwealth of Official Use Only
: ,�'�\� Massachusetts Permit No. BLDE-22-002048
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)
City or Town of: YARMOUTH Date:the Inspector/12/2021
By this application the undersigned gives notice of his or her intention to perform the electrical work d sc ibed below. of Wires:
Location(Street&Number) 56 BROOKHILL LN
Owner or Tenant QUINN EDWARD P II
Owner's Address QUINN ANN R, 149 28 HAWTHORNE AVENUE, FLUSHING, NY 11355 Telephone No.
Is this permit in conjunction with a building permit?
Yes 0 No 0 (Check Appro ;: ,
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 �`)
New Service AmpsUndgrd ❑ 4.!itti '
tC
Volts Overhead 0 Undgrd ❑ � "
Number of Feeders and Ampacity ,Location and Nature of Proposed Electrical Work: Replacement boiler. � ' , 4 _
Completion of the followingtable ma abe/" gi
Y t e cif)Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of g
No.of Luminaire Outlets Transformers C KY
No.of Hot Tubs Generators
KVA
No.of Luminaires Swimming Pool Above ElIn- ElNo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners
FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners 1 No.of Detection and
Initiatine Devices
No.of Ranges 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 Heating KW Local 0 Municipal
Connection 0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters KW No.of Ballasts Data Wiring:
Signs No.of Devices 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: 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.fp perjury,urY,that the information on this application is true and complete.
FIRM NAME: ROBERT E BOWDOIN
Licensee: Robert E Bowdoin Signature
LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 51981
Address:502 PITCHERS WAY, HYANNIS MA 026012582 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.:
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.
Owner/Agent
Signature Telephone No.
I PERMIT FEE: $50.00 I
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