HomeMy WebLinkAboutBLDE-21-007224 a Commonwealth of
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E. Massachusetts Permit No. BLDE-21-007224
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:6/11/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 245 BLUE ROCK RD
Owner or Tenant REGAS SHIRLEY N Telephone No.
Owner's Address 245 BLUE ROCK RD,SOUTH YARMOUTH,MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No. w
Existing Service Amps Volts Overhead 0 Undgrd 0
I V rs
New Service Amps Volts Overhead 0 Undgrd 0 o.o tt it
Number F us and Ampacity
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Location and Nature of Proposed Electrical Work: relocating existing generator \7 /\
Completion of the following table may\bbe j t1fieU of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.os /�/Vr` al
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators
No.of Luminaires Swimming Pool Above ❑ In- 0No.of Emergency Lighting‘-3
grnd. t;rnd. 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
Tons
No.of Waste Disposers Heat Pump Number Tons KMNo.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Other:
Connection
No.of Dryers Heating Appliances KR Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts 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: 07/21/2021 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 ❑ (Specify:)
1 certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: RANDALL C AGNEW
Licensee: Randall C Agnew Signature LIC.NO.: 17492
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:381 OLD FALMOUTH RD,MARSTONS MILLS MA 026481555 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
signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owners agent.
Owner/Agent
Signature Telephone� No. PERMIT FEE:$50.00
FN?L OZ. t ov 1) -1-keiceet t•vS,)na., c)'Z�2`...r. e