BLDE-21-001304 Commonwealth of Official Use Only
ft* Massachusetts Permit No. BLDE-21-001304
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) Date:9/15/2020
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 668 ROUTE 28
Owner or Tenant CAPTAIN PARKER"S PUB Telephone No.
Owner's Address THE PARKER RIVER REALTY TRUST, 121 MAYFLOWER TERR, SOUTH YARMOUTH, MA 02664-1120
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install sub panel&wire septic controls(Permit to clear expired permit
E20-0117)
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 Total
Transformer KVA
No.of Luminaire Outlets No.of Hot Tubs Generator O KVA
No.of Luminaires Swimming Pool g bove ❑ Igrnd ❑ No. 1 'Ml., rgen, Ri_ •
rnd. Bat • s. Q
No.of Receptacle Outlets No.of Oil Burners FIR , / o. r
No.of Switches No.of Gas Burners No.of Detec ,,
,,,,,-..,70. 8p.
Initiative Devices
No.of Ranges No.of Air Cond. Total
Tons No.of Alerting Device
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alertine Devi
No.of Dishwashers Space/Area Heating KW Local 0 Municipal -.0**- / I t er:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No
No.of Devices or Equivalent
HeatersWater KW No.of No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 2 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: WILLIAM C FLIGG
Licensee: William C Fligg Signature LIC.NO.: 12584
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 FREEMAN RD,YARMOUTH PORT MA 026752304 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 No. PERMIT FEE:$100.00