HomeMy WebLinkAboutBLDE-23-002365 Commonwealth of y
of r' Official Use Only
l% Massachusetts Permit No. BLDE-23-002365
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:11/1/2022
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 9 WILFIN RD
Owner or Tenant MATTHEW DREW t
Telephone No.
Owner's Address \ ,-.
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: Replacement HVAC.
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
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No
No.of Devices or Equivalent
HeatersWater KW No.of No.of Ballasts Data Wiring:
Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 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: 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No.
I PERMIT FEE:$50.00 I
` 4 Official use nay
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ertplecent "z3 --
f Occupancy Fee CheckedTli-!;t0111"--t------=---,•;'. OF
TIONS .1./071 Nam blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wodtto be artaimed in accordance with the MassacimseiliElichical Cock; - 527 CMR°I200
(PLEASE PR T ININ%Olt TYPE ALI.INFORMATION) Date: l L ?11 �;
City or Town of "' r n'i c id-f`r) To the Ir ctor of Wires:
By-this us his or her intention to perform the electrical work described below
Location(Street&Number) 9 Lai_ n —pc'
15h l y n c Lr14 P,it� r�l _ Telephone No.$3a= '] 7 53 43
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building Yes ❑ No ri (Check Appropriate Box)
Furpose of Bonding
thilityAuthorization No.
Fig Service, Amps I Volts Overhead 0 tlndgri❑ No.of Meters
New service Amps I Volts Overhead 11 tJokar31 _ No.of Meters
Number of Feeders and Ainpacity
Location and Nature of orfc f 7
r
o}-ihe,kil,>7 v table maybe rcevedby the Inspector af Wires.
No.of Total
No.of Recessed _ No.of C Fans Transformers ICYAi
No.of Luminaire Outlets No.of Hot Tubs Generators KvA
-0_of Emergency Lighting
No-of Lambskin SCataannam Pool A21e Li tt 0
No.of Iteceptadeendets No.of Oil/turners -1 ALARMS To.o'er 1
No.of : of Gas Ill/inters
No-of I?etectiaa and
1 * - No.ofAirCend. Tons I o.ofA
elliag Devizes
Nu_Of W_Disposers ' Tons KW No.of Self-contain ed
,� - �Device
Nc.ofDryers Rea
KW mks Systems:*
Na. ,, "titer No. , i of ,. of Devices or t
Breatets KW
Wiring:
Equivakut
No,of ors Total B$ T t n - ti' fba:
No.of or Equivalent
Estimated Val of We 'S 0 Q v o Whoaich tom ' or as by Inspector of Wires.
Work to� I G •� _ :.:� to berequired by�Wailes
CODINURANCE GE: � inaccordance wilit I�G RoleI4�auk tledon.
the licensee l of w o �no Ibr of k issue unless
certifies �.�isi force,mid� or its The
cllEcK t B€ 'D El tf (Specify.)
proof t icsrsic► ,its
Imo, .. olb,t the hi ( fy'o
FIRM NA, is tie end complete.
! lute lam: 1 - -
a Alt;T eL N
OWNER'SlIW� Iam et the - �' 2`liabiTityc
rewind by OwierLAgent
1 Bym$ w,I� vethis d b dieIIoverage r 0 owner's
normally
nt