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Home My WebLink AboutE-18-2151 Commonwealth of Official Use Only 110114\137°. Massachusetts Permit No. BLDE-18-002151 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked • JRev.i/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:10/11/017 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) 62 CAPT STANLEY RD Owner or Tenant KOPFER PAUL TelephoneNo.sz2Q7._p1, Owner's Address 2 GODWIN DR,WYCKOFF, NJ 07481 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 0 Undgrd ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Air conditioner • 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 ❑ 1n- ❑ No.of Emergency Lighting grnd. grnd. Battery Ito its 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. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Ileat Pump _Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Ileating Appliances KW Security Systems:" 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 IIP 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (Ifapphcable,enter"exempt"In the license number line.) Bus.Tel.No.: Address: 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 RN — IZA I 64(2606 CIA IN atlet r 2 _.t /J � Commanru y of///eaSaC eftsA. else Only '�'= -7 c7 ('� •.. 'Permit No. ` (u� 24 sc _akaJcparf is d pit.Piro Services BOARD OF RRE PREVENTION REGULATIONS Occupancy and Fee Checked . 1/077 ' (leave blank) Q • APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALLINFORM4770N) Date: is /ll ' aoI —i To the or Town of: YARMOUTH �— Inspector of Wires: By this application the imdeisigned gives notice of his or her intention to perform the tie:Mical work described below. • . Location(Street&Number) 6 ,a C 4 PnI- t/ STA Q z GY RD • Owner 'r Tenant p?u!✓ k o r r/= 2 Telephone Nccg/.2( y Owner's Address 61 CA-PTA(Al ' I7WLGy R0. Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters _ New Service Amps / Volt Overhead ❑ Undgrd ❑ NO.of Meters Number of Feeders and Ampacity -- • Location and Nature of Proposed Electrical Wort. r V 1 D, 1419 if c , 110 t/ Dl R Ee T 1...y Ca ---I fi I ti-re 14/r: u N IT W Completion of the following table may be waived t y the In pec or of FPaes N 1% No.of Recessed LumINo,of CetiSusp.(Paddle)Fans Tra inairesNo,nsof I Total formers KVA No.of Luminire Outie�s LU .-i a INo.of Hot Tabs IG-aerators • KVA. ' V U No.of Lumf¢aires (Swimming Pool '°'hodve tri- [filo. IIo.or emergency taghung gra . grad_ aitr w 0No.of Receptacle Otiets . . No.of OR Burners (FIRE AI-ARMS INo.of Zones C.f. m d No.of Switches No.of Gas Burners No.of Detection and h Initiating Devic.er No.of Ranges INo.of Air Cond. / Toa 2,s No.of Alerting Devices No.of Waste Disposers IHeaT Primp I Number Tons KW No.of Self Contained Totals: Deo.of.on/Alertine Devices No.of Dishwashers ISpacearea Heating KW' -oral Municipal ❑Connection 0 Oma No. of Dryers (Heating Appliances )KW Security Systems:` No.of Water No.of Devices or Equivalent No.of No.of Heaters Stens Ballast Data Wiring No.of Devices or Equivalent No.Hydromassage Bathtubs INo.of Motors Total HP Telecommunications Wiring: - No of Devices or Equivalent O t HtR Attach additional detail if desired or as required by the Inspector of Wirer. Estimated Value of Electrical work I CC (When required by municipal policy.) Strut � P cY') Work to St 7 Inspections to be requested in accordance with MEC Rnie 10,and upon completion. INSURANCE C GE: 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 0 BOND 0 OTHER 0 (Specify.) I certify, ander the pabtr and penalties ofperjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (If applicable,enter "exempt"in the license number line) Address: Bus.TeL No J `Per M G.L c. 147, s_57-61,securityrequiresAlt.Tel.No.: work Department of Public Safety"S"License: Lic.No. �e OWNER'S INSURANCE WAIVER: I am ware that the Licensee does not have the liability irLsurince coverage normally required b. law. $y my Si�amr wo be ,I h eby waive this requirement Iam the(check one) wner owner's agent al Owner/Agg ental 1fJAA'A"tt"ff"IIS�iiL/� Na Sie�natrsre TefephoaeN aril I alti D510 y I PERMIT FEE: S 1 � :•