E-18-3769 tCommonwealth of Official Use Only
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E�i` r!►i Massachusetts Permit No. BLDE-18-003769
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
.(Rev.l/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:1/2/2018
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) 6 JACQUELINE CIR
Owner or Tenant WEBB ANDREW C _ Telephone No.
Owner's Address LINGOS TATIANA I,200 HINCKLEY RD, MILTON,MA 02186-2853
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 0 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: Install security system
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 TotalTransformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Ab ❑ In- ❑ No.of Emergency Lighting
grnd.ove grnd. Batter/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
Initiatina Devices
No.of Ranges No.of Air Cond. TTotal No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine 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 Eauivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Siens Ballets 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 ❑ 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:
Licensee: Signature LIC.NO.:
(Ifapplicable,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: $45.00
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BOARD OF ARE PREVENTION REGULATIONS YOev. )/p7]ncy cleave blank) —
APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All wort to be perform d in accordance with the Massachusetts Elecnica!Code(MEC),527 CMR I ZDO
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: t.2.4241'7
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the Imde siwed es notice of his or her intention to perform the electrical work described below.
I
Location (Street&Number) Cheilt -s'E Gc , , R .L.F e •
Owner•orTenant �ItsRE V.7gaA Telephonelfo,l'1_6tc_7-Zia
Owner's Address afi e �.4 C{Lf�j-t � (��L:'to�{ MA-- 0 2p 4b--�
Is this permit in conjunction with a budding permit? Yes ❑ No
Purpose of Bmfg im ,(Z�S L ❑ (Check Appropriate Bot)
U"'{-T 1 k L- Utility Authorization No.
Eristiag Service Amps / Volts Overhead
❑ Undgrd❑ No.of Meters _
--„ New Service Amps / Volts Overhead
❑ Und d
❑ Nri,of Mutons _
'.y v sr I Number of Feeders and 4mpsd y
•
'lot s ii � Location and Nature of Proposed Eleciricsl Work. �1
II —.1! o D-enol , W u-►A 6 W S smote.?
wfr-c �` F . .
Completion oft)ie follawnc table cry be waved by the Inspector of Firm
••Y 54 IIS No.of Recessed Lan*.,.:--P. INo of Ca-Sttsp.(Paddle)Pats • INo.of Tout
Transformers KVA
I c� No. of Lum=„t Outlets No.of Hot Tabs
aiXf ! G-aerators KVA '
11r , = No. of Luminaires Swimming Above ❑ in- ❑ No.or emergency l.x;ncag
,. Pool Drnd rod. !Batter?Uara
No. of Receptacle Outlets . No.of On Burners
FERE 44L4-8M5 lNo,ofZon=
No. of Switches No.of Gas Burners No.of Detection and 1 S.
No.of Ranges Thtzi Iai',:atine Devices
•
INo. of Air Cond. Tons No.of Alerting Devices 1 S
No.of Waste Disposers 'HeatPump !Number 'Tons KW (N o.otSetf-Contataed
Totals: _ IDe'`etion/4lertino Devices
No. of Dishwashers ISpace/Area Heating KW' I ❑ Men cipal
Connection aCrtaer
No.of Dryers Heating Appliances KW Security Systems:°
No. of WaterKW I No. of Na.of No.of Devices or Equivalent
DataHeaters Wiring
Signs Ballasts No of Devices or
1 No. Hydromassage Equivalent
g No. of Motors Total HP
Telecommunications Wiring:
Na.of Devices or EQuivalent
—
•
•
Attach additional detail tf desired ores required by the Inspector of Wirer.
Estimated Value of Electrical Wort;
Work to Start (When rot)trired 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 ofnce.
CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I terrify, under the pains and penalties ofperjusy,that the information on this application is true and complete,
FIRM NAME:
LIC NO.:
Licensee: Signature �
(If applicable, enter "ezempt"in the license mrmber line.) LIC.NO.:
Address: Bus.TeL No•���—
,J `Per M.G.L.c. 147,s.57-61,securi work requiresAlt.TeL No.:
ry Department of Public Safety"S"License: Lie.No. --------
a OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally
required I • By y signature b ow,I hereby waive this requirement I am the(check one 0 ownero
kg
//� , ty0 owner's a env
Signature 'Tele hone .t... n '3 40) PERMIT FEE: $
P,