HomeMy WebLinkAboutE-17-5999a Commonwealth of
Massachusetts
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. BLDE-17-005999
Occupancy and Fee Checked
Rev.l/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 INFORAMTION) Date: 5/17/2017
City or Town of: YARMOUTH To the Inspector of INres:
By this application the undersigned gives notice ol his or her intention o per orm the a ec is work described below.
Location (Street & Number) 51 WINTER ST
OwnerorTenant SWANSON DAVID B Telephone No.
Owner's Address SWANSON SHEREE L, 51 WINTER ST, YARMOUTH PORT, MA 02675
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service 200 Amps Volts Overhead ❑ Undgrd ❑ No. of Tteters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Serviceupgrade
Completion of the following table may be waived by the Inspector of {Vires.
No. of Recessed Luminaires
No. of Ceil: Susp.(Paddle) Fans
No. of Total
Transformers KV
No. of Luminalre Outlets
No. of Ilot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. rnd.
No. of Emergency Lighting
Battery rnits
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 Devi
No. of Ranges
No. of Air Cond. Total
No. of Alerting Devices
No. of Waste Disposers
[lest Pump
al.:
Number I Tom I KW
No. of Self -Contained
Detection/Alerting Devi e+
I I
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal E3Other.
Co nection
No. of Dryers
Ileating Appliances KW
Security Sxstems:"
No. OfI) vices m uIva lent
No. of Water KW
1 at .
No. of No. of
Si n. Ballasts
Data Wiring:
DVI or Eauivalent
No. Ilydromassage Bathtubs
No. of Motors Total IIP
Telecommunications Wiring:
o D vices n u I n
OTHER:
Attach additional detail ifdesired 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 ❑ OTIIER ❑ (Specify:)
I certify, under the pains and penalties ofperjuty, that the Information on this application is true and complete.
FIR.11 NAME: William C Fligg
Licensee: William
enter "exempt" in
Signature
NO.: 12584
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)
Owner/Agent
Signature
❑ owner ❑ owner's agent.
Telephone No. I PERMIT FEE. $50.00
l�on"norvcaltla o{ �77i/aSJn[ ,.. /0
�5e/ia�l Use�O'nlny /�
1JePerfmcr o� lir+ Jcrviee� Petffit No.
BOARD OF FIRE PREVENTION REGULATIONS O pe7JyandFmChechd Q�
(lerve bleak)
APPLICATION F0R*P5RMIT TO PERFORM ELECTRICAL WORK
.4p work to be perf=med in eceord:am with the Mtnarhusctrs Electrical Code (MELT, 527 CMR ZDV
(PLEASEPMT IN pv; OR ME AU MORM4770NJ Date: — --
City or Town of: A R MOUTH To the Inspector of FPrres:
By this application the imdet3iJed gives no ce of his or ba intentitm to perform the electrical wort des . below.
Location (Street & lumber)
Owner'orTenant t
k Telephone No.
Owner's Address --------
Is this permit in conjunction with a building permit? Yes
❑ No (Check :4pproptiaL+Boz)
Purpose of BuiIrImg Utility Authotintion No.
Elis — Service ,amps < outs Overiiead Q pndgrd [3 No. of Meters
New Servitx Amps / Volts Overhead E]d Und
°.r ED N6of Meter
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work 54� JA
GiL._ ,(Q v�OfL
No. of Recessed Lamt.,ri
No. of Lmmina;r. Outlets
N . of Ltrm:nz;ree
No. Of Reeeptade Duties
No. of switches
No. of Raages
NO- Of Waste Dirpmen
No. of Dishwashers
No. of Dryers
No. of Wzter
Heaters KW
No. Hydromassage Bathtubs
OTHER
of Coil.-Susp. (Paddle) Fags
sof Hot Tubs
ntmingPool '1D0Pe � ln- ❑
Brad. Brad.
of Ott Burners
of Gas B-trraers
of Air Cond.
T
ren Heatiae KW
Appliances KW
No. o
s Bath
of Motors Total HP
e waived by rhe h,n,..r,._ _rn
KVA'
AL;RN S INo. of Zones
Of AIxtia; Devitxs
❑O
r1wnzpu ❑ Oher
ivaoi urvtees or
a Wang:
Na. of Devices or
Estimated Value of Electrical Wort: Aaach additional detail if desired or m mgWred by the Inspector of Wires.
Work to Start:-� (When required by �cipn policy.)I Inspections to be requested in accordance with MEC Rile 10, and upon completion.
IIQSURAN OVER4GE: Unless waived by the owner, no permit for the peti'ormamce of electrical work may Issue inns
the licensee provides proof of 1iab1ty insvrmce including "completed operation" coverage or its substantial apivaient Tire
undersigned certifies that such coverage is in forge, and has eahlbited proof of same to the pmmit issuing ofnce.
CHECK ONE: INSURANCE ❑ BOND ❑ OTTER ❑ (Specify:)
I cer*, a"a r amdp O , thatformats n on this appgcdion is true and campsda
Ficins NAME:e \ t N G Cvr LIG NO.:
License
Of applicable, enterSIgna LIG NO.:
Addresr. epi u to �'° licersre numbe) Bas. TeL No
'Per M G.L. e. 147, s. 57-61, scctaity work regni Alt Tel. No
resDepartment of Public Safety"S" Lcensr
Lia No. ��
OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insur,n
ce cov a n—�
r b law. By my si gnatore below, I bereby waive this requirement I am the check one �8 turn!]
tJwaerd/Agent ( ❑ owns ❑ owner's a rat
Signature Telephone No. PERhTIT FEE. s