HomeMy WebLinkAboutBLDE-23-002364 Commonwealth of Official Use Only
. I Massachusetts Permit No. BLDE-23-002364
' 0 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) 2107 HEATHERWOOD
Owner or Tenant ROTH GERTRUDE TRS Telephone No.
Owner's Address ROTH WILLIAM J TRS,2107 HEATHERWOOD,YARMOUTH PORT, MA 02675
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 furnace
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 ❑ 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
Initiatine Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Devices
Totals:
No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Siens 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.NO.: 51981
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:502 PITCHERS WAY, HYANNIS MA 026012582 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 my
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: $50.00
Q Use Only
Cttt Permit No_'t-.Z3—Z34
as' aid Fee Ch rked
€Y
OF FIRE REGULATIONS - (leave blank)
APPLICATION F ,PERMIT_TO PERFORM ELECTRICAL WORK
(PLEA,Vg PRINT.I1iINKOR INFORMATION) Date: 10 �.�I a 2..E
City or Town of: ye) (�11'1L)i I To the Ins r of Tres_
By-this application theundersigned gives noticeof his or her intention M perform the electrical work described below
Location &Number) c9.101 t1eathtrW U Oti
Owner or Tenant er1(14 a-e_ 1Z O+1,-) -- Telephone No.1,1 Li l t°_Yq-;/ -
f 3waer's Address Yes El No �'`1 (CheckAppropriate Box)Is this lit in conjunction with a bonding permit? �y.Autboaatstiou No.of Building
Existingimpose
Service Amps I Volts Overhead Et Uadgrd D No..of Meters
New Service Amps - I Volts Overhead 0 tat;tad L No.of Meters
Number of Feeders and Ampacity
Location mad Nature of Proposed Electrical Worms sire a c 3u'6-10
ConsIdetion of the follawb‘bide may bewaived by the Inspector of fire..
No.of Recessed Luminaires No.o"# - --a Fain Transformers KVA
No.of Limandire Outlets No.of not Tabs Generators KVA
t Above 0 L 1la of
Eniefgency Lighting
ioloNo..of OB Burners /TIRE.ALARMS No.of Ames
' .of �j� di
(<�� N .of�}
and 1
*ter. - '$(1.d Gas - t'ye"kes
of -No.of it�. t ag i No..of
Alerting Devi=
No-o€Wsisfe Disposers Totai=
of ' Space/Area II
.x
- No.ofDryers Haab Appliances Kw Security f !or Equivalent
No,ofWat l of No.of 'Da Heaters BaRasts r
Devices or .-Emdmdeat
do i
No. Bathtubs No of s Total of or t
Co Attack addaicaol detail&faked.or au Hof Wires_
P �Value won 51' .� , required
We*ID S 0 1_?a-; teh in accordancewhir MX Rale 10.,me upon completion-
11613BANCE
00` 2-' Maks ' ,03 � of unless
the licensee mixt—des prof of _ _ - ing'completed.operatine mew arils'*Went. The
ondercieriedeenirms that such etr,rwage is in force,mad has eYbriiiteil woof ofsa to dm permit issuing office.
INSURANCRX BOND [1 OTHER El (om)oniudion. on ' application is irr€e and complete,
, i and off?t in, '
FIRM PW., = LIC Na:
E
.Tee.: ` / 1
A I C � a0 r. ,A t`fie 'tit k.l i ,� U flit_Tel.No__
Vcr mak c..147,s.5T-41,sermity wort ofratfiu Safety 'Linens= Lie.No.
ROMANCE WAIVER: I mit awaretlutt a Limonee does not have theligraity insurance coveragm normally
axakedby kw. Witty signature below,Ihereby Iam the(check one)El owner El owner's agent_
OaveriAgent