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Home My WebLink AboutE-19-595 a" Official Use Only k�E �a� Commonwealth of Massachusetts Permit No. BLDE-19-000595 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:7/30/2018 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) 34 FROST AVE Owner or Tenant RON DORY G Telephone No. Owner's Address RON MARINA L,34 FROST AVE,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 ❑ Undgrd 0 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: Wiring for 1/2 bath in basement. 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- ElNo.of Emergency Lighting grnd. grnd. Batten,Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 No.of Gas Burners No.of Detection and Initiating 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/Alerting 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 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. t 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: Paull R Cudak Licensee: Paull R Cudak Signature LIC.NO.: 28598 4f applicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address:46 DORIC AVE,PO BOX 324,W DENNIS MA 026700324 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S LNSURANCE 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 a 9/22-/, 6 , a amino. /7 ei l.ommontoea al�jwlacl al.tt, omc'nl Use Only k cCyA c7 x`19 - o s . €!P= 1Jeparfinenf of Jive Serviced Permit No. -.t' , Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank) 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 INFORM/177019 Date: City or Town of: YARMOUTH To the Inspector of Wires: • . By this application the undersigned gives notice of his or/I her intention to perform the electrical work described below. • Location(Street&Number) 3 t{ •r ec.cT A ,/G Owneror Tenant `) a rR� es v'i Telephone No. Owner's Address 3 J'r t-(' -as+ A tCse, yo EAR IsIs this permit in conjunction;� with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 'J v-ttj( Utility Authorization No. Existing Service_ Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead 0 Undgrd 0 Ne.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: (,)./t.� ,7 6 niL &w t eite,g-r .h Completion of the followinqtable may be waived by the Inspector of fres. No.of Recessed Luminaires No.of CeiL Snsp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abod.ve 0 In-d. Batt0 No.ofery UEmnitsergency Lighting grrt • No.of Receptacle Outlets al- No.of Oil Burners FIRE ALARMS IND.of Zones No.of Switches a- No.of Gas BurnersNo.of Detection and Initiating Devices - No.of Ranges No.of Air Cond. Ton 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' LoralMunicipal ❑Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data W[rin 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 ifdesired or as required by the Inspector of Wires. Estimated Value o Electrical World S Q 0 (When required by municipal policy.) Work to Start 7 (V Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE 0 RACE: 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 certify, under the pails and penalties ofperju ,that the info • ."• • on this application is true and complete. FIRM NAM 1, /� a , LIC.NO.: 7C..ctif , Licensee: Signature i i, LW.NO.: (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No... R'.3 �C�r3 Address I� a 7 Tel.No.: j `Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: AIL Lie.No. TO fr` 39y-letrS3 - 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 ❑owner's agent. Owner/Agent % Signature Telephone No. ...... I PERMIT FEE: $