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Home My WebLink AboutBLDE-19-001124 a Commonwealth of Official Use Only J /A Massachusetts Permit No. BLDE-19-001124 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.l/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:8/23/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. Location(Street&Number) 248 CAMP ST UNIT H1 Owner or Tenant NORRIS JANICE RACINE Telephone No. Owner's Address 248 CAMP ST HI,WEST YARMOUTH,MA 02673 Is this permit in conjunction with a building permit? Yes ❑ 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: Install paddle fan in second floor bedroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans 1 No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1:1No.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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton. No.of Waste Disposers Heat Pump Number Tons KW ,No,of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 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 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: Mark H Chase Licensee: Mark H Chase Signature LIC.NO.: 8669 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:21 DRAKE ST,YARMOUTH PORT MA 026752204 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 `^I 1 1 ,..ommoruvealth o//t/wear (il Official Use Only v' 1 _ ccam�. �'J 1 ?fit The arimant oil Jim Permit No. _ p an'icss Occupancy and Fee Checked SSW" i 05.0) • t L- BOARD OF FIRE PREVENTION REGULATIONS ev. l/07j . (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORM4TIO?9 Date: 8 d 3 /I City or Town of: YARMOUTH To the Inspector o>Wires: . By this application the undersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) a Se s�T N- I Owner'orTenant T/41,-) PO/L.(.I ,S • Telephone No.jedzasuclag a Owner's Address o11-(t islinP -r- H-I to. Y' r„.4Lt inn e'?4•73 0 t ..Is his permit in conjunction with a building permit? Yes ❑ No 11��--11 / f� (Check Appropriate Box) ill N f wPI'pose of Building Utility Authorization No. ao g > N ¢E.isting Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters Ll(I jw I w Service Amps / p os veread 0 Und rd .of Meters V = i I tuber of Feeders and Ampacity • W Q o 'cCation and Nature of Proposed Electrical Work: 7-sug-ctrl( 1- cari-c- it a,,,1- R- T m m - Completion of thefollowine 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 LuminairesSwimmiPool Above ❑ In- No.of Lmergency Lighting ng ernd. grnd. ❑ Battery Units No.of Receptacle Outlets 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 No.of Air Cond. Total No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number `Tons I KW No. of Self-Contained - Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' I l Municipal ❑ Connection ❑ OthP. No.of Dryers Heating Appliances KW Security Systems:' No.of WaterNo.of No.of Devices or Equivalent Heaters No.of KWData Wiring; 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 ifderired or as required by the Inspector of Wires. Estimated Value of Electrical Work; (When required by municipal policy.) 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 Lig.. BOND 0 OTHER 0 (Specify:) I cern;fy, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: 04 SE c62-G7,z.(r-- Go .oC LIC.NO.: SGC Licensee: (77/1/2.“- Am Signature LW.NO.: (If applicable enter:exempt"in the license tuber line.) Bus.Tel.No.. -Lieill Address. PD. I�o2e 'Pict' -se licen,'S /f491' t5�a-66'G' Alt. �z ySeLe7� j *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: `c.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n o — O red Agent by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent Signature Telephone No. I PERMIT FEE: $ 1