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Home My WebLink AboutE-19-2395 Commonwealth of Official Use Only • elp Massachusetts Permit No. BLDE-19-002395 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:10/22/2018 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) 30 BLISCOTT AVE Owner or Tenant GISBOURNE PAUL T Telephone No. Owner's Address 136 AMHERST AVE,WALTHAM, MA 02451-3170 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 Ampacity Location and Nature of Proposed Electrical Work: R&R electric heater&thermostat. 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 ❑ In- CINo.of Emergency Lighting grnd. grnd. ,Battery Units i 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 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 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: Thomas J Madden Licensee: Thomas J Madden Signature LIC.NO.: 14065 (Ifapplicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address:39 MARINERS LN,PO BOX 291,YARMOUTHPORT MA 026750291 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 atedi. iofz.3/fg e J .✓ . ammo. monk ei Y/Iaefachuselfs Use Only lig Occupancy Apartment .7i n ��-3�S _..`��- Apartment el.7irs J Permit No. Services (f ' Occupancy and Fee Checked ' BOARD OF FIRE PREVENTION REGULATIONS ev. 1/D (leave blank) APPLICATION FORJPERMIT TO PERFORM ELECTRICAL WORK All work (� to be perfommd in accordance with the Massachusetts Electrical Code C),52]CMR 12.00 1 (PLEASE PRINT V1INI;OR TYPE ALL INFORMATION) Date: /D,4a//de City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives n ti of his or her inter•on to perform a elecq�calwork described clow. • . Location (Street&Ni ber) 30 d 3c.O f -e -O. ire e/ Owner orTenant � Gr! Dt.r� Telephone No.71�3rj 1y / Owner's Address /36 Mm h cis Arte 116/74a Ptirefff r a)VS-i 0 Is this permit in conjunctiqu with a buildingpermit? ^[J Yes 0 No (Check Appropriate Box) l' • Purpose of Building Q fUtility Authorization No. Ez sting Service/CO Amps �)C) /t:20Volts OverheadIn"-----Undgrd❑ No.of Meters Q 1'e v Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters wW m �Va abet of Feeders and Ampacity • >t N don and Nature of Proosed EirMical Wong; .e�Ov� 4,/n /G n 'yFG'I�L Nb,SO YA/ T/i/f?q•/L-r '�S'7i4?— In (! ecE'YQ^Jr1ii 1/4% Completion ojtbe follawinp fable may be waived by the Inspector ofWires. ` of Recessed Luminaires Na of Ceti S (Paddle)Fans • No.of Total w �' Transformers KVA o of Luminaire Outlets No.of Hot Tubs Generators KVA Ce • No of Luminaires Swimming pool Above In- No.ofl;mergenry Lighting — grnd. grid. 0 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 I'otal No.of Ranges No.of Air Cond. Tons 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 HeatingKW' Munici al !oa1 0 Connecptton 0 Omer No.of Dryers Heating Appliances 4.5"2,0Kw Security Systems:* No.of Devices or Equivalent No.of Water No of Heaters KW No.of Data Wiring Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additions!detail if desire[(oras required by the Inspector of Wires. Estimated Valu of�lec cal Wo±3 6t.2.0° (When required by municipal policy.) Work to Start:to 0 p R ry') ��aa Inspections to be requested in accordance with MEC Rale 10,and upon completion. INSURANCE OVE 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 undersigned certifies that such coye9gcts 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 ••ins • •penalties a •e 'ury,that the information on this application is true and cornpier FIRM NAME: ifa c--IL '� " ' LIC NO. 105— Licensee: IC . (Jfapplieable. er" I/ Signature g� .NO.:G� /10 G �r�mpt' in t1�license ber in..,l Bus.Tel.No.•� Address. /SOX a.---cl��r f - J *Per M.G.L.c. 147,s.57-61,securitywork requires!_" Alt.Tel.No.: OWNER'S INSURANCE WAIVER I am are that the Department Safety 1 a e thLicense:liabilityLin.insurance c � required bylaw. By coverage n— o�— qw my signature below,I hereby waive this requirement. owner's agent. I am the(check one)0 owner 0 t Owner/Agentr Signature Telephone No. I PERMIT FEE: $ �7