HomeMy WebLinkAboutBLDE-21-001302 Commonwealth of Official Use Only
4E� Massachusetts Permit No. BLDE-21-001302
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:9/15/2020
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pettorm the electrical work described below.
Location(Street&Number) 668 ROUTE 28
Owner or Tenant CAPTAIN PARKER'S PUB Telephone No.
Owner's Address THE PARKER RIVER REALTY TRUST,121 MAYFLOWER TERR,SOUTH YARMOUTH,MA 02664-1120
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: Re-feed air conditioner(Permit to cover expired permit E19-0787)
Completion of the following tg6l�'m/ waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. VV``"" 61*.
\�� Total
Tr KVA
No.of Luminaire Outlets No.of Hot Tubs Gen /� ANo.of Luminaires Swimming Pool Above ❑ In- 0 No.of Em r�r�XaJ)g(itinp
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zone
No.of Switches No.of Gas Burners No.of Detection and - ''s
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Device /
Ton
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 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KN 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 HI' Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach ark/Wow/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 certrfy,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: WILLIAM C FLIGG
Licensee: William C Fligg Signature LIC.NO.: 12584
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 FREEMAN RD,YARMOUTH PORT MA 026752304 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 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$80.00