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Home My WebLink AboutE-18-2382 Commonwealth of Official Use Only lA\ Massachusetts Permit No. BLDE-18-002382 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked LRev.1/071 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:10/23/2017 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) 984 WEST YARMOUTH RD Owner or Tenant NOTEVA TANYA Z Telephone No. Owner's Address 150 DEPOT ST, DENNIS PORT, MA 02639 par Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate lax es Purpose of Building tility Authorization No._2 075j( Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meter New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wring 8,service for garage with apartment. 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(lot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting grnd. grnd. Batter'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. TotalTon No.of Alerting Devices No.of Waste Disposers that Pump Number Tons KW. . No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers !hating Appliances KW 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: 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 El (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Robert W Pierce Licensee: Robert W Pierce Signature LIC.NO.: 12359 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:12 FOSTER RD, E SANDWICH MA 025371040 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 0 owner's agent. Owner/Agent Signature �rTelephone No. yam, �i'r1 'PERMIT FEE:/ $230.00 € CCAV th7 I (17) ( ) (CF, r wt'(e0e0 �ea- el f O"��J -- s ta ni1f, ctc alarbb gm v cop e:v. ✓44/Jp . • div f01-en-t'9) SI/i/As 7t to -11$9q c) +l1ovat 523101 gyp $7 eueri no snrwt 2 +Ao lA q 2(Yars(y4 9 -wr cel cv4d7d ,119551/2 ifs c720-n 9119511H 3-4 /IA' 3rv's5'N r (Taagl _xt.1.4, lccofnMonwea of��'77 ¢Sdaachays :• Permit No. m ��!/ 7 [�- • alit 1Jeparlmenf c{.yira Sento Occupancy and Fee Checked BOARD OF ARE PREVENTION REGULATIONS Rev. 1/07] . (leave blank APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK .411 work to be performed in accordance with the Massachusetts Electical Code WC),527 CMR 1200 (PLEASE PRINT IN MK OR TYPE ALL INFORMATION) Date: City or Town of: yARMQUT HTo 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) qgq 41,1 r Seen f4 ye/ .Owner'or Tenant P/01. AUrrk-V ��L Telephone No(flz12•Z3(,g Owner's Address SRw4e, ___________ Is this permit in conjunction with a buil a _✓ �permit? Yes No ❑ (Check Appropriate Box) ' Purpose of Building 5 asst. t w/ orb Utility Authorization No. Existing Service_ Amps / Volts Overhead 0, Undgrd❑ No.of Meters -- New New Service ZOO Amps /2-o/Z.110 Volts Overhead❑ Undgrd❑r"- NO.of Meters _L Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work.- Sa v v t G Q roil (" id-- .� • 1 �7 tett(^ tJrrt, nq Completion ofthe foEowine table may be waived by the Inspector of Wirer. No.of Recessed Luminaires INa of Ceil.Susp.(Paddle)Fans Transformers KVA No.of LuminaireOattem INo.of Hot Tubs ICr_nerators • KVA ' No.of Luminaires (Swim m;ng Pool Above In- o.of .mergency lrghung — '_rnd .1:1ernd_ CI (Ratted IInits No. of Receptacle OaBets No.of Oil Burners (FIRE ALARMS INo.of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices - No. of Ranges INa of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers HeatTotals: DetePrimp I Number Tons KWNo,oef toSelf-Containa Ded n)Mertinevices No.of Dishwashers • Space/Area Heating KW' j,cial Municipal ❑ Connection 0 Other No.of Dryers (Heating Appliances SecurityNf Devicesoror Equivalent No.of Water q Heaters KW No. of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: — Na of Devices or Equivalent v OTHER q Attach additional detail rf desired or a required by the Inspector of Wires. t Estimated Value of Electrical Work: 11 yma (When required by municipal policy) / • Work to Start p Inspections to be requested in accordance with MEC Rule 10,and upon completion. c! INSURANCE CO G : Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance inching"completed operation"coverage or its substantial equivalent. The J , undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �-•� I cat", under the pains and BOND 0 OTHER 0 (specify:) of perjury,that the information on this application is true and complete. d FIRMNAME: !Sob 7�1e u f7 feGrC tli Z LIC NO.: /-2 33-PLO Licensee: (3n h Rev-et Signature)27,4- 2c5 : ; LIC.NO.: $0,0--e.— of applicable, enter "ezemp( 'in the license number fine.) s. (L Fss V Bus.TeLNo:C / L22- , Address: AGI F' SkµJ(s-1tq //4 OZ53� Alt TeL No.: 'ie" - ..1 `Per M.G.L. c. 147,s.57.61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent t Owner/Agent al Signature Telephone No. I PERMIT FEE: $