BLDE-19-001514 A
0. Commonwealth of Official Use Only
afMassachusetts Permit No. BLDE-19-001514
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
,IRev.1/071
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:9/13/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of ms or her intention to perform the electrical work described below.
Location(Street&Number) 33 JANICE RD
Owner or Tenant MACDONALD MARGARET M Telephone No.
Owner's Address 33 JANICE RD,SOUTH YARMOUTH,MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead O Undgrd ❑ 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: Replacement oil burner.
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 ❑ ln- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners 1 FIRE ALARMS I 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 U.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: IAN B JACKSON
Licensee: Ian B Jackson Signature LTC.NO.: 39860
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:273 MAIN ST, HARWICH MA 026452467 Alt.TeL No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"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 J
cej
a2fi31"/9 ,t'
. A C.ommonmean o`///assachsdeus .4 Official Use Only
Permit No.o ..7{H Sendaiis
131-r
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07]
(leave blank)
APPLICATION FORPERMIT 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: a t 1t% CS
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) 33 S-a,11\tG2 i(t'_oA-IS.
Owner orTenant Telephone
Owner's Address M��/ � �� bo � No.
Z3 Onte e anA-1s 59.Jfl Vet,no
Is this permit in conjunction with a building permit? Yes ❑ No E1
(Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Und rd
} 0 NO.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 3 3 „Tea^ta.. Itc'itk+,
W 12F riga, v i 1 bt/2rv,f_d_
•
Completion of thefollowin table may be waived by the Inspector of Wirer.
No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans o.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
• No.of Luminaires Swimming Pool
Above ❑ In-arnd. BNo,oflmergency Lighting
grnattery 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 Mr Cond, Too No.of Alerting Devices
•
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW' LocalMunicipal
❑ Connection ❑ er
No.of Dryers Heating Appliances KW Security Systems:'
No.of Devices or Equivalent
No.of Water No.of
Heaters KWNo.of Data 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 if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 25Z) (When required by municipal policy.)
Work to Start: 47142.-a3 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 cove
ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE (BOND 0 OTHER 0 (Specify:)
I cernJy, under the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME:
LW.NO.:
Licensee: .ip n i'' C(-ce_m.Son I Signature
af .N . Q LIC.NO.: F_39Rt p
applicable,enter"exempt"in the license number line.)
Bus.Tel.No.•
Address:
J 'Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety Alt.Tel.No.:
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance overage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent
Owner/Agent
d Signature Telephone No. . I PERMIT FEE: $ I