HomeMy WebLinkAboutBLDE-23-003489 Commonwealth of Official Use Only
!E' V A Massachusetts Permit No. BLDE-23-003489
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.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:12/27/2022
City or Town of: YARMOUTH To the Inspector fWires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 87 STRATFORD LN
Owner or Tenant COLLINS JAMES Telephone No.
Owner's Address COLLINS ELAINE HINTSA,87 STRATFORD LN,YARMOUTH PORT,MA 02675-14. C
Is this permit in conjunction with a building permit? Yes 0 No 0 (C k+,. :, t. e Bob w
Purpose of Building Utility Authorization tin ' '«]'�/
Existing Service Amps Volts Overhead ❑ Undgrd ❑ o
New Service Amps Volts Overhead 0 Undgrd 0 N.
Number of Feeders and Ampacity •
i/�J /
Location and Nature of Proposed Electrical Work: Interior wiring of battery encloser,Installing smoke detector, o r
Completion of the following table may be wa t ,spector of Win
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of otal
Transformers WKVA
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 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tong
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
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.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Sinns No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER: 1
Attach additional detail if desired,or as required by the Inspector of Wir
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: TRINITY SOLAR INC
Licensee: Bruce Junior Signature LIC.NO.: CSFA-067961
(If applicable,enter"exempt"in the license number line) Bus.Tel.No.:
Address:8 Somerville Street,Marshfield MA 02050 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:$45.00