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Home My WebLink AboutE-19-1393 ,/ „ a Commonwealth of Official Use Only felF Massachusetts Permit No. BLDE-19-001393 �.,t, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.l/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:9/6/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 109 BAYVIEW ST Owner or Tenant CONOVER JEFFREY D Telephone No. Owner's Address CONOVER MICHELLE R, 109 BAYVIEW ST,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Wiring for pool. 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 Arndbov.e 0 Ingrn•d. InNo.of Emergency Lighting `/_,._ gBattery 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 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 ❑ 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: Julius Prizgintas Licensee: Julius Prizgintas Signature LIC.NO.: 20442 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:97 CHUCKLES WAY,MARSTONS MLS MA 026481583 Mt.Tel.No.: 'Ter 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:$65.00 yea vidofie re- �/77 yyyy C.ommona of///assackuse fs _ OfSciai Use Only _ >�, �9- 1393 �VNL.o- ==min �11art art,,,,,,o/ s Permit No. I ervicea N ==►_►s BOARD OF FIRE PREVENTION REGULATIONS -Rev. and Fee Checked t'' 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 INFORMATION) Date: 9/6 //4 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 Jr Number) 109 en' toe-m, s T Owner Or Tenant if/C//E((r eG/vo (/.t-,P Telephone No. Owner's Address gnne- Is this permit in conjunction with a building permit? Yes [ No 0 (Check Appropriate Box) ' Purpose of Building five/,/VC Utility Authorization No. Existing Service /COAmps //O / 24,Cfolts Overhead a Undgrd41 ❑ 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 Wort ui/Fe /Gac Vt ^eo chug/0004 to • Completion ofthe folknring table may be waived by the Inspector of Wires. ((( ��-. No.of Recessed Luminaires No.of Cel.-Susp.(Paddle)Fans • o.of Total Transformers ICVA - No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- No.of li mergency t.tghtmg gird, grnd. 0 Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones 0 11,10 of Switches No.of Gas Burners , of Detection and m •-' Initiating Devices 0 of Ranges Total I�i.:-=—, 1d No.of Air Cond. Tons No.of Alerting Devices (�co I I of Waste Disposers Heat Pump Number Tons KW No,of Self-Contained Totals: W I �r Detection/Alerting Devices V a ia�'or of Dishwashers Space/Area Heating ICW I ❑ M nneeb'oln 0 other — Ill U n I,it,.. of DryersHeating Appliances y Security Systems.' I No.of Water No.of No.of Devices or Equivalent et Heaters KWNo.of Data Wiring: Signs Ballasts Na.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: — No.of Devices or Equivalent OTHER: _ Estilnat al Value of Elecuicai Wor>` Attach additional detail(desired oras required by the Inspector of Wires. Workm to Start (When required by municipal policy.) 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: INSURANCEC 'BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties o perjury,that the information on this application is true and complete. FIRM NAME: tiUL/0 Pee/26'/A'74 S• LIC.NO.: fi.�ff Licensee: ice,//Of iensenu /trine) Signature of",..., LIC.NO. (If applicable,enter"exem t• 'n the license number line) �l` Bus.Tel.No.. O 0el/' Address. 97 CN O(.C(l--s WI! ///x•.ftr/-$ /ft et f j Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety Alt.Tei.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLin.insurance c et required bylaw. By coverage no's agey q� my signature below,I hereby waive this requirement I am the(check one) owner ❑owner's agent t Owner/Agent Signature Telephone No. I PERMITFEE:S �$,(�