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Home My WebLink AboutBLDE-19-000215 Commonwealth of Official Use Only ��•.�►� Massachusetts Permit No. BLDE-19-000215 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked fRev.1/07j 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:7/11/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. Location(Street&Number) 134 CAPT NICKERSON RD Owner or Tenant BORKOWSKI DOROTHY Telephone No. Owner's Address 134 CAPT NICKERSON RD,SOUTH YARMOUTH,MA 02664 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 Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install basement receptacles. 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 0 In- 1:1No.of Emergency Lighting grnd. grnd. Batter,Units 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 Initiative Devices No.of Ranges No.of Air Cond. 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 Data Wiring: Heaters Stens 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 0 BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 51391 (if applicable.enter"erempt"in the license number hne.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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:$50.00 e e4 / g I(j cu,) ! Car Wk-24/ ✓tact ComMosupealth.of rr/amac fb Official Use Only 3 r-M yip P / s Permit No. `n!= e arfinent o Serviced J BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev. l/D7j cleave blank) - APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK AU work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 V W LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Inspector of Wires: c., ¢ I y this application the pndersigned gives notice of his or her intention to perform the electrical work described below. ru• m °cation (Street&Number) /39 &P? Ail Ckerl sn / o J ,i I weer Ur Tenant e,s 4- .4.1„:7. � n /3,,'` /P�Ar �S,�'i Telephone No. 6:,/7- 77507/7 Li ° Ii wner'sAddress C / 3karAM.,. Ali 4/ Cilesr,✓tir (4,1/ 4,26, may( 7 at • ,IYs this permit in conjunction with a building permit? Yes ❑ No 24-- (Check Appropriate Box) _—_ _IPurpose of Building Utility Authorization No. Existing Service_ Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacfty Location and Nature of Proposed Electrical Work: G/f{'JE f- fAtslq 1/ a /2..-9, 4.4.Q,vo— OCompletion of the follawinvable may be waived by the Inspector of Wires, U 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 CS • No.of Luminaires Swimming Pool Above In- No.oThmergency Lighting - Brod. grad. 0 Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners • No.Initating Devices and _ 'YU[ Initiating No.of Ranges Na of Air Cond. Tons No.of Alerting Devices j_,' No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained - �+ Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Leal Municipal D Connection 0 Other a—., No.of Dryers Heating Appliances KW Security Systems:* fit%(( No.of WaterNo.of Devices or Equivalent Heaters KW No.of No. of Data Wiring: 3 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 Wirer. Estimated Value of Electrical World (When required by municipal policy.) 4 Work to Start: Inspections 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 0 OTHER 0 (Specify:) I cert)", under the pains anfpeennalties ofperjury, at the in ormation on this application is true and complete. FIRM NAME: )1,�-p r ( I ec,l 73 JC Licensee: a, 10 f A ignature LIC.NO.: (If applicable,enter"exempt"in th license number linea Bus.Tel.No.: e Address 7 f(/1tlysulk i pi , t I, 7/ rMQ• -is- Alt,Tel.No.-S08.-5-40 j 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. 3,417/ - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal) irequired by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent r Owner/AgentDoSignature Telephone No. ( PERMIT FEE: $ �(