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Home My WebLink AboutBLDE-19-001791 .0 Commonwealth of Official Use Only a. f Massachusetts Permit No. BLDE-19-001791 — BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked FRev.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:9/25/2018 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) 29 SCALLOP RD Owner or Tenant CHLECK FAMILY FOUNDATION INC Telephone No. Owner's Address C/O CHLECK DAVID,254 VILLAGE BLVD#4103,TEQUESTA,FL 33469 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) A _,/j, Purpose of Building Utility Authorization No. 2294913 �G�" Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Temporary service 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 0 Iq- 12No.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 Tont No.of Waste Disposers Heat Pump Num r 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 ifdesired,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 ❑ BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: DAVID BALFOUR Licensee: DAVID BALFOUR Signature LIC.NO.: 22363 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.; }kJ 9 t/'9/3 Address: 14 STARBOARD DR.MASHPEE MA 02649 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 we / /1g ( _ l.anunonraee&el Pl assac ffJ �Officciial Use Onl (� v ='ei= �r. sParfa sat of vire.�eroiw Permit No.�f C '1 I '!fOccupancy and Fee Checked 52)44BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07j (leave blank) •f_ APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK ea Z All work to be performed in accordance with the Massachusetts Electrical Code 527 12.00 .....7„. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 97� > City or Town of: YARMOUTH a To the Inspector of Wires: ujij . By this application the pndersigned gives notice of his or her intention to o the electrical work described bel gLocation (Street es Number) p2 S e� 'i do „1 I / / ,Yq//// c IA o .Owner'orTenant Da4. S0./ 1 (VSs dui f' 4J Telephone Na. �f0�-770 t)C Ce 1.:.::.; r Owner's Address / 7 y v e/ (///e Acme �'�& 1a 7 Is this permit in conjuncdo with a building permit? Yes ❑--No ❑ (Check Appropriate Box) Purpose of Building 7 S'tc-oM re Utility Authorization No. it,a 9 4 Cf / t Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service ana Amps 2-f" El Overhead Undgrd 9" No.of Meters / 172.4 rs, Number of Feeders and Ampacity cQ Location and Nature of Proposed Electrical Work: —TZ nn c a coo9eat- CQ -F cI) clop �t)r e- TM UCompletion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires Noof CeiL Snsp.(Paddle)Fans • No•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA - No.of Luminaires Swimming Pool Above 0 In- No.ottmergency Lighting - ernd. ernd. ❑ 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 Coml. Too No.of Alerting Devices • No.of Waste Disposers Heat PumpNumber Tons (KW No.of Self-Contained Totals:I I_ Detection/Alerting Devices No.of Dishwashers • Space/Area Heating KW' Leal 0 Municipal Connection 0 Other No.of Dryers Heating Appliances 1311 Security Systems:" No.of Water No.of Devices or Equivalent No.of Heaters No.of Data Wiring Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER • Attach additional detail if desireet or as required by the Inspector of Wires, Estimated Value of Electrical Work: 4 Odd (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 cov a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify^.) f certify, under the pains and penalties , pe 'umy,th, the information on this application is true and complete. FIRM NAME: II t / ' IC, alk - LIC.NO.:_ Licensee: inflow / Signature ::/ar��/ LIC.NO. `4 (If applicable,enter "exempt"in the license tuber�;,,.) / !r Bus.Tel.No.: Address: _ tr -tar e -(Alt.Tel.No.: j J `Per M.G.L. c. 147,s.57-61,security work requires Department o Public Safety"S"License: Lic.No. ,-,:e OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n — required by law. By my signature below.I hereby waive this requirement I am the(check one)❑owner 0 owner's agent. s Owner/Agent 3 Signature Telephone No. I PERMIT FEE: $