HomeMy WebLinkAboutBLDE-23-002363 Commonwealth of Official Use Only
kt Massachusetts Permit No. BLDE-23-002363
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) 107 GREAT WESTERN RD
Owner or Tenant HOLT BARRY W Telephone No.
Owner's Address HOLT TARA N, 107 GREAT WESTERN 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. -
_
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 air conditioner.
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 No.of Detection and
Initiatine Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
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 Signs 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: $50.00
Ri a/ ��s /Ot l Use Only/�'}�
A_-. rf w Permit No_ £Z- -ZGJ( j
LT-
" �= ' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev_IR)7] ( =blank)
APPLICATION F0,1 PERMIT TO PERFORM ELECTRICAL WORK
All workto be otifoimed in accordimee with the idassaclmsetts Electrical Code C) CMR 1200
TFASFPRINTIRMKOR TYPE ALL INFORMATION Date: I U% 3 '' -)---
City or Town of: c r( 1 c I.K`r'1 To the ctor of Wires:
By this application the-undersigned gives notice of his or her intention to perform the electrical work described below_
Location(Street&Number) I 1 - ��rc',i+ llama-f-i-n Pci
Omer or Tenant •3<' ('l j-{-hI Telephone Na 11(1-7 L -.2 3 9(
Owner's Address U
Is this permit in
conjunction with a building permit? Yes No I 7 (Cheek Appropriate Boa)
Purpose of Bful[iiing Utility Authorization No_
Ong Service Amps I Volts Overhead I I Undgrd[] No.of Meters
New Service Amps I Volts Overhead❑ Undgrcl U No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed�Wor 0 I s Co n r)ec "' I S e-Cot),-) Eh 47L-,
Completion n of the:= = r .a/Me stay be waived by die Inspector of Wires.
of
No.ofR No.oCeB-- P.(Paddle)Fans �Transformers Total
iNs ofZ,m$inair'e Outlets No.of Hot Tubs Generators KVA
Above1 No_of a aency Lighting
No.of POol Q LI Batten'Ullits
No.of Receptacle
Outlets a No.of OH Burners ' l' ALARMS fri .of Zones i
No_of Detection and r
No.of S No_of Gas Burners Initiating Devices 1
Total eL of Alerting Devices
No..of No.of Air Cond. Tons I
l I IeatPu I Number I Tons {KW No.of Self-Contained
# ( ;. >: •,>.Amur Ile.�icee 1
No.of ' ,Space/Area Heater KW 1 ';. Q cooriectiort LI "her
Security Systems:-
No.of Dryers Beating Appliances I,' f Devices or Equivalent
No.of Wad No.of No.of Data Wiring:
lipsKW
Sntris Ballasts Na of Devices or ale t
Telecommunications�' a:
Nu.Hydra ge Bathtubs 'Na a of Motors Total BP Na of Devices or fdtgiva eat
OTHER:
n U J Attacharl i mi de tf t or as respiredby theInspector of Wires.
71
Estimated V- _: . -- Worms 5 o C/.. (When required by municipal Policy-)
Work Start r j q • Insperfions is he rem in octnidootz with MEC Rule 10,and upon completion.
1140.MANCE(D Tr e.' • I?nless waived by 1lw ovum,ma emit for the Fafonraurce of electrical work may issue unless
the licensee provides proof of liability insurance indudirg"compleWd operation'averageor its substantial equivalent. The
t si =tiros that such his in fen,x,and has exhillited proof of SIMto the p itissuing office.
CHECK I SUR A. , BOND Q OTHER LI (SPecif )
I certift,under the pains ansurs-ofpajary,that the information on ' appOcation is true turd complete.
FIRM NA3 `! LIG NO.:
�"'
t:'. 1 I3 f-f- EBo 11 is
Gt11 LICNO.r.,51 /Si - F
afivritpilti mapraazigir is ti .TeL No i 1 V-3 bS-e-�3(,`
Address I P (1 t�Ci b 4 Ii'1G
t ,in A C~' 3 Alt.TeL No'
M.G.L.iTer c.147,s.5741,seaway wort requites ofPublic Safety`S"Lim: Lie.No.
OWNER'S Bk5URANCE WAIVER: I on aware that the Licensee does not have the liability insmanec coverne normally
required by ii1W. Bymy sigma=below,I hereby waive this c/u I am the(theck one)0 owner II owner's agent
Owneri�- Telephone No. I- •3