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Home My WebLink AboutBLDE-17-001012vf-� Commonwealth of official Use only Massachusetts PermitNo. BLDE-17-001012 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' 8/29/2016 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention o pe orm e e ectnca work described below. Location (Street & Number) 34 HATCH RD Owner or Tenant PUCHALSKY DAVID H Telephone No. Owner's Address PUCHALSKY MAUREEN K, 34 HATCH RD, SOUTH YARMOUTH, MA 02664-1937 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 100 Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace distribution panel and upgrade grounding 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- ❑ rnd. grnd. No. of Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number I Tons I KW No. of Self -Contained Detection/Alertine Devices I I I No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: JEFFREY T FOSS Licensee: Jeffrey T Foss Signature LIC. NO.: 36938 (Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.: Address: 33 SULLIVAN RD, W YARMOUTH MA 026733543 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) ❑ owner ❑ owner's agent. Owner/Aeent Signature Telephone No. F(w e (z 7 (((, 16 �f, PERMIT FEE: $50.00 CommoruveatUz o/ ma-66aeii I& _ , Oficial Use Only �cPari`mcni o f J irc JcrviccJ Permit No. llJ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked • ev. 1/07] (leave blank) APPLICATION FOR= PERMIT TO PERFORM[ ELECT IC WORK All work to be perfomned in accordance with the Massachusetts Electrical Code pp (PLEASE PRINT IN INK OR TYPE ALL INF0R1dIATION) Date:41 City or Town of: YARMOUTH To the Inspect r of ��S. By this application the t,uidersigned gives notice of his r her intention to perform the elec 'cal work described below. Location (Street & Number) �;,I �� Owner'orTenant ` s Owner's Address Telephone No. �/i J s_ 04 Is this permit in conjunction with a building permit? Yes ❑ No V (Check Appropriate Box) Purpose of BtriIdiag Existing Service Amps Utility / 00 Volts Overhead ❑, L 1 �l_ New Borneo Amps _ Volts OverheadUnda ❑ J s_ 04 Is this permit in conjunction with a building permit? Yes ❑ No V (Check Appropriate Box) Purpose of BtriIdiag Existing Service Amps Utility / 00 Volts Overhead ❑, Authorization No. Und6r e No, of Meters New Borneo Amps _ Volts OverheadUnda ❑ .rdM No, of Meters Number of Feeders and Ampacity Location and atare of Proposed pectrical Work; �+ Com letian of the allowing table m be waived b the Ins ector of FPLres. No. of Ceil,-Susp. (Paddle) Fans No, of Total No. of Recessed Luminaires No. of Luminaire Outlets INo. --of Hot Tubs Transformers KVA Generators Zti'VA ' No. of Luminaires (Swimming Pool Above ❑ !n- end ❑ o. of mergency a ting Battery No, of Receptacle Outlets . arid. No. of Oil Burners Units FIRE AlAP—MS No. of Zones No, of Switches No. of Gas Burners o. of Detection and No. of Ranges No. of Air Cond. Total Tons Initiating Devices No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: umber 'TonsIKW[[No, ____(DetectionhUertina of elf -Contain Devices No, of Dishwashers Space/Area HeatingKW 1'0� Municipal ❑ Ofi►er No. of Dryers No. Heating Appliances KW Connection Security Systems:* No. of Devices E of A ater Heaters KW No, o No. of or uivalent Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No, of Motors Total HP Telecommunications Wiring: OTHER: No, of Devices or E uivalent __�] Attach additional detail if desired oras required by the In of 4Yires. Estimated Value&tctri WorjL (menrequired by municipal policy.) Work to Start:Inspections to be requested in accordance with MEC Rule 1Q, and upon completion. INSURANCE C: 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 offs e. CHECK ONE: INSURANCE X BOND ❑ OTTER ❑ (Specify:) �!/�%��ev��!®� /p I certify, under the pains and penalties of perjury, that the information on this application is true and complete- r NAME: LIC. NO.: Licensee: Signature LIC. NO. (Ifapplicable, a ter "exempt" • th lie e r fine Address: Bus. Tel. No.: "Per M.G.L. 47, s. 57-6I ,Alt security work requires epartznent of Public Safety "S" License: L c1. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n� ly required by law. By my signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's a ent Owner/Agent Signature Telephone No. PERMIT FEE. $