HomeMy WebLinkAboutBLDE-21-003301 Commonwealth of Official Use Only
0 ti Massachusetts Permit No. BLDE-21-003301
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
APPLICATION FOR PERMIT TO PERFQ ,LE ` ', CAL WORK
All work to be performed in accordance with the Massachus.tfs Electrical Code (MEC),527 CM' 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of: YARMOUTH Date:the Inspector
0
To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical ,irk described below.
Location(Street&Number) 8 PIERCE ST
Owner or Tenant SOUZA CHRISTOPHER J
Telephone No.
Owner's Address 8 PIERCE ST, WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No
Purpose of Building (Check Appropriate Box)
Utility Authorization No. 4574117
Existing Service Amps Volts Overhead 0 Undgrd 0
New Service AmpsgNo.of Meters
Volts Overhead ■ d 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Upgrade service&install r septa -s . counter.
Coin do of the followir table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddl Fa s No.4df Total
Tnsformers KVA
No.of Luminaire Outlets No.of Hot Tubs
Generators KVA
No.of Luminaires S, 'mming Pool A nd a ❑ No.of Emergency Lighting
grnd. Battery Units
No.of Receptacle Outlets 5 No.o e it Burners
FIRE ALARMS I No.of Zones
No.of Switches No.of Gas :urners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Con Total
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I umber I Tons ` KW No.of Self-Contained
Totals: I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating K Local ❑ Municipal
> 0 Other:
No.of Dryers Connection
Heating Appliances KW Security Systems:*
No.of Water / No.of Devices or Equivalent
Heaters KW No.of ,''No. i f Ballasts Data Wiring:
Signs ;r No.of Devics or Equivalent
1
No.Hydromassage Bathtubs No.of Motors / Total 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 t e requested in accordance with ME♦Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by the ow er,no permit for the performance of elect 'cal work may issue unless the licensee provides
proof of liability insurance including"completed ope/r Lion"coverage or its substantial equivalent.Th• undersigned certifies that such coverage
is in force,and has exhibited proof of same to the po`i-mit issuing office.
CHECK ONE:INSURANCE 0 BOND a OTHER 0 (Specify:)
I certify,under the pains and penalties o er ur that the information on this applications true and comp le..fP .% Y.
FIRM NAME: John J Ennis
Licensee: John J Ennis Signature
LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 11032
Address: 7 STEWART LN, KINGSTON MA 023641377 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.T No.:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally requ' ed 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: $75.00 I