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HomeMy WebLinkAboutBLDE-19-002392 - Commonwealth of Official Use Only v Massachusetts Permit No. BLDE-19-002392 - , BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.l/07) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfomed 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) 10 ELM LN Owner or Tenant KELLEY JAMES M Telephone No. Owner's Address KELLEY ARDELLE P, 10 ELM LANE,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 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: Replacement boiler&water heater. 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 In- CINo.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 1 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:" No.of Devices or Equivalent No.of Water 1 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. 17I-501-37v4 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. �l O IN ft c' n t b FIRM NAME: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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 QFC I0(-7.-3(i 8 ta- 4. //�� ammws onat of Massachusetts assac its Official se Onl2 1Jepar(mant oi Yin Permit No. 0 - J / 2 r'si srvius d _z- BOARD OF FIRE PREVENTION REGULATIONS•tri- Occupancy and Fee Checked fRat UM] •• (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELE TRI AL WORK :›•. All work to be performed in accordance with the Massachusetts Electrical Code(ME• ,527 , r 12.00 (PLEASE PRINT ININK OR TYPEALL INFORMATT01>7 Date: / , � r City or Town of: YARMOUTH To the Inspe. or of "fres. . By this application the undersigned Fives c of ifs area/1,,, intention to perform the ele • cal wo • described below. . Location(Street&Number) I .sA,Qr Owner orTenant TIM/ .e( �"l/, Telephone No. Owner's Address ! Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check A ro Purpose of Building ... PP Priate Box) Utility Authorization No. 0 Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters LO New Service Amps / Volts Overhead 0 Und grd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: cif /'.� ©/ D /a �+ ----loll �,' Completion of the fo/lawin&tab/e maybe waived by the Inspector ofW Wire` la m NO? tressed Luminaires No.of CeB Snsp.(Paddle)Fans No.of Total Transformers KVA N NQ�f umfnaire Outlets No.of Hot Tubs Generators KVA IIJ Lit Np'Uof uminaires Above In- No.oftin eu v Swimming Pool ❑ erg cy tlghung grnd grad. ❑ Battery Units o V U Ni o eceptacle Outlets No.of OE Burners FIRE ALARMS INo.of Zones Lu o - IC: I Nwo witches No.of Gas BurnersNo.of Detection and •'. — Nd°ai nges Total Initiating Devices No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number ITons IKW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal Loal❑ onnection ❑ eT No.of Dryers Heating Appliances Kw Security Systems:" No.of Water No.of No.of Devices or Equivalent Heaters No.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 ifderired or as required by the Inspector of Wires. Estimated Value of Electrical World (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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE g BOND ❑ OTHER ❑ (Specify;) I certtfy, under the pains and penalties ofperjury,that the informs&l on th' Tilt".n is tru and complete. FIRM NAME: ,,///a LIC.NO.: Licensee: Qr / �1�1:��/ `�� as.— Signature�,�, tt7/11r`� LIC.NO. ♦ (IfapplicablA enter"exempt"in the iq*te�pyipberrline) 1774 / r " � Address: 1- f/(/fiC/eOJi7471 . tendpie1lleve(tF, J7/ %$as.Tel.No.• tL .j. 199 j Per M.G.L.c. 147,s.5}C6I,securitywork re b /e('v Alt Tel.No.: quires eparanent of Pu 1 Saf "S" icehse: Lic.No. _� e OWNER'S INSURANCE WAIVER: I am aware the Licensee does not haw the liability insurance coverage normally -C required by law. By my signature below,I hereby waive this requirement. I am the(check one)D owner ❑owner's agent. t Owner/Agent .1 Signature. Telephone No. I PERMIT FEE: $ S'()