HomeMy WebLinkAboutBLDE-23-005876 Commonwealth of Official Use Only
BLDE-23-005876
Massachusetts0 Permit No.
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:4/24/2023
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) 59 CAPT CHASE RD
Owner or Tenant STJOHN WILLIAM V Telephone No.
Owner's Address STJOHN REGINA, 16 CHAMPLAIN DR, HUDSON, MA 01749
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 o Meters
New Service Amps Volts Overhead 0 Undgrd ❑ ‘,,Z.NN1
r
Number of Feeders and Ampacity O
Location and Nature of Proposed Electrical Work: Wiring for five zone ductless.
dp,
Completion of the following tab4‘/.. ,
may , • te4n or of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of
� otal
Transformers ;0KVA
i!
No.of Luminaire Outlets No.of Hot Tubs Generators VA
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. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: 1 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 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
—� Only
��O�icial Usc
�// si^/n/,/,, c�ire.11i petit No. C./:
(6�'r 1^ c7 ((�� cy and Fee Checked _.----------
,!..."1-„,
..' ...b: ,�,f,q,G,,,wl o/..fist Jiswlcee Zupan t0
Rev. I/071 ICave blank
Li
WORK BOARD OF FIRE PREVENTION REGULATIONS [
ELECTRICA '
�Q,527 CMR 12.00 e
performed in accordance with the Musscbusatts ElxMcd C, t y/a 3
APPLICATION FOR PERMIT TO PERFOR
I Ali*sac to Date: c- C
(PLEASE PRINT IN INK ORT�'P�ALL INFORMATION) To the Inspector of Wires:i descri�d�lo„v. t [
City or Town of: `C6t rMDI l-'� We etectriea
vas ottceofhtao*heititttt °"� rig- 1 OS�t3 10 [
By this application the undersigned� Ca G i h G5�
Location(Street di Natptxr) Telephone No. t 1.[
Owner or Tenant I
S oh 12.1
Owner's Address No (Check Appropriate Box) 13
Yes ❑
Is this permk in conjunction with a building permft7 Utility Authorization No.__________--_ 14.
Purpose of Building______---------- Undgrd❑ No.of Meters
Amps —yes Overhead 0 No.of Meters
Editing Service _ Volts Overhead❑ Undgrd 0
eY'
Amp' __� --- 1st
Number of Feeders and AmpecitY tau
glect call Work: n c- UG
L,ocatioo and Nature of Proposed =
be wah+ed, the t .. ,- tor o hires. 1
..,tenon o the allow' : table
Fans Transformers KVA
No.of Recessed L,nminaira No.of Cdi.-Soap•(Paddle) KVA
No.of Hot Tubs Generator.
No.of Luminab�e Outlets _ •O.o 'mhergenCY 7 a
No.of Luminaires Swimming Pool ,, d e ❑ ' d. ❑ Ba Units r
No.of Receptacle Outlets No.of OU Burners . ,
No.of Zones
No.of Switches No.of Gas Burners lnitiatin. Devices
, n No.of Alerting Devices
No.of Ranges No.of Air Cond. Tons
__ ___ `o. �+71 f o "
•, ,T p ..1111P.., _c.........PAL_ . ... _ tb°/Akn 1•rtinl:Devices
No.of Waste Dispssen Municipal No.of Dishwashers Space/Area Heating KW local 0 CSonnection 0 °thi.
No.of Dryers
Heating Appliances KW No.Security
fDevices or Univalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
T W
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Univalent
OTHER:
R
/, Attach additional detail ifdesired or as required by the htspector of Wires.
Estimated Value of El 'cal Work: U o, _ (WhCn required by municipal policy.)
Work to Start: i q c 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: 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 sue v e is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
l cert/fy,under the pal neities of perjury,that the inform on this lkadon is true and complete.
FIRM E: LIC.NO.:
Licensee:K Ub er e_ t,1 a a 1 r Signature L1C.NO.:519 $/ P
(If applicable, "wrist,'"in the c e►wrier line) v„,,pus.TeL No.;
Address: ( I lv)C 1,i'1 Utz+'1 Rd 41'1�+OU i it k a3'A1t TeL No.:
*Per M.G.L. c. 147,s.57-61, ity work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally
.equired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner y owner's agent.
?wn I PERMIT FEE: $ I
ilgnasure ture Telephone No.
,.111111