HomeMy WebLinkAboutE-18-953 Commonwealth ofOfficial Use Only
(S\ Massachusetts
Permit No. BLDE-18-000953
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:8/18/2017
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice at his or her intention to pertorm the electrical work described below.
Location(Street&Number) 58 PUTTING GREEN CIR
Owner or Tenant BALLOU SUSAN C TR Telephone No.
Owner's Address SUSAN C BALLOU REV TRUST,3 HILLCREST PARK RD,OLD GREENWICH,CT 06870
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 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Am pacify
Location and Nature of Proposed Electrical Work: Wring for 2 bathrooms,2 closets,&hallway.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 8 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting
_ grnd. grnd. Rattery Units
No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones •
No.of Switches 8 No.of Gas Burners No.of Detection and
Initiating Devices
,
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Toni
No.of Waste Disposers Ileat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Tinting 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 11P Telecommunications Wiring:
No.of Devices or Equivalent
OTIIER:
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: MICHAEL S SOBY
Licensee: MICHAEL S SOBY Signature LIC.NO.: 10097
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:66 Lake Dr,Orleans MA 02653 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$75.00
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�a art„:rife c�'7yY [� .Permit No.
'_� P lYine Serviced -
' Occupancy and Fee Checked
-_- BOARD OF FRE PREVENTION REGULATIONS
. 1/07) (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 ININK ORTYPE ALL INFORM4T10A7 Date: /a /0 to
City or Town of: YARMOUTH To the Inspector of Wires:
. By this application the)mdersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 'l_aireo A - _ ♦ - / i
Owner'orTenant � A ((a,2 Telephone No.
Owner's Address
Is this permit in conjunction with a buiidina emit? Yes No ❑ (Check Appropriate Boz)
• Purpose of SmTdingeffThr ivy. )P f(',4 Utility Authorization No.
Existing Service /tet Amps Pi i a Volts l Overhead
Undgrd❑ Na.of Meters /
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
•
Loea�ion and&&tare of ProposedyElectrical/Work: t, - ,E-/- a _, i i
. _. .. .. * 2 C i,597-S . . [/ _ ..----..-. ...- . . - .. .
Compl..'. of the following.table may be waived 6y the Inspector of Wirer.
No.of Recessed LuminairesINo.of Ca-Soso.(Paddle)Fans No.of Total
Transformers KVA
No.of LuminaireOudets it !No.of Hot Tubs ILGenerators KVA '
No,of Luminaires 0 ISwfmm:ng Pool Above ❑ bi- INo.at)emergency Lighang
crud. ernd. ❑ Battery Units
No.of Receptacle Outlets Q • No.of Oil Burners FIRE ALARIYIS No.of Zones
No.of Switches 67 No.of Gas Burners -No.of Detection and
' hitiatma Devices
No.of Ranges No.of Air Cond. Tons Tons No.of Alerting Devices
• Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers ISpace/Area Heating KW' I Municipal
Connection 0 Other
No.of Dryers (Heating Appliances KW Security Systems:*
No.of WHater e tees KW INo. of No.of Data Wi Wiring:
o.of g ccs or Equivalent
Signs Ballast 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 Electical W-orrl02:7"-- (When required by municipal policy.)
Work to Start: ilk /! TM/Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C RAGE: 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: NSURANCE$ BOND 0 OTHER 0 (Specify:)
I certify, under the pion and penrrrAes f perjury,ttha`t the information on this application is true and complete.
FIRM NAME: aretT t e `frocr rcle0e LIC.NO.:
Licensee: // _ iia Signature ,rnt� l. LIC.NO.: l' =Y`�
(If applicable,ent e/mp�t' m e kris. =miter I. e.) .4111.P-gra
Address. , e...lri fir `���' �� y4- .0 Bus.Tel.No.:����[ca?(
' ` Alt.Tel.No.:
,j Per M.G.L.e. 147, s.57-61,security work requires Department of Public Safety"S"t c . . Lie.No.
— OWNER'S INSURANCE WAIVER I am aware that the Licensee does nor have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. 1 am the(cheek one)0 owner 0 owner's agent
t Owner/Agent
j Signature Telephone No. I PERMIT FEE:$ l
I