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Home My WebLink AboutBLDE-18-005686 Commonwealth of Official Use Only i ` Massachusetts Permit No. BLDE-18-005686 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IJRev.l/071 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:4/11/2018 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) 40 KATES PATH VILLAGE Owner or Tenant FIELDS FRANCIS X Telephone No. Owner's Address FIELDS GAYNOR A,40 KATES PATH,YARMOUTH PORT,MA 02675 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 ❑ No.of Meters Number of Feeders and Am pacify Location and Nature of Proposed Electrical Work: Replacement furnace 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 Bot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- ❑ No.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 • Inuiatine 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Beating Appliances KW Security Sstems:• No,of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens 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 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, FIRM NAME: DANIEL J PECKHAM Licensee: Daniel J Peckham Signature LTC.NO.: 26830 (If applicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LN,MARSTONS MLS MA 026481629 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 saki, S (0/wee J l., ..or..m•"rri a/7444 ,h . . Oraeiel Use Only J g= l� / [1 Per:Mt No. 0 —S SG!) BOARD OF ARE PREVENTION REGULATIONS vro7)and Fee Checked �Z (lease blank) APPLICATION FOR•P€RMIT TO PERFORM ELECTRICAL WORK 411 wont to be per.•orm d in ete"„Isice with the Massachusel3 Electrical Code(MEC),527 CM/beat 12.00 (P�-SEPRINT DVMIKOR 1YPEALLINFORMg770N) Date: /> ByCity or Town of: YARMOUTH To the .ector of Wires: this application the lmde signed gives notice of his or her intenton to perform the eleectical work-described below. • Location(Street&Number) urn -7-&5 ?G7 1 Owner orTenant 1F�r4Yl�S Telephone No. Owner's Address �� mIs this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Bot) [U.!1 ...11.0 y ?upose of Em7timg ;.� N < IItlity Authorization No. p Existing Service Amps / Volt Overhead IA .--� ❑ IIn�grd❑ No.of Meters New Service Amps / Volt Overhead Und d ❑ ;r ❑ NO.of Meters Vw ¢ o Nnmb-a of Feeders and Ampadty Location and Nature of Proposed Electrical Work: II 1L m its L1l-/ �I,I1(hil4Yt.,,et/ t'U/L/44C✓ .. _ .__ _.._. Cmrm/e'ian of the foIIowaq table m be waved by_the Inspector officers No.of Remsed L¢n*nii;-m IVa of Ca-Burp.(Paddle)Fans No.o£ Tout (Transformers I VA No. of Luminaire Outlet INn.of Hot Tabs IGeaerators EVA ' No. of Luminaires 157'r*ming Pool Above 0 In.- INn*of tt:aerg_ncy Ufl g erred. ernd. C Bahasa Unit No. of Receptacle Outlet INn.of Oil Burners IF= ALARMS No. of Zones No, of Switches INo.of Gas Em-aera `Na of De` ¢on �— • JI! Iii irdne Devices No.of Raagn 'No. of Air Cont Total _ • Tors No.of Alm-ting Devices No.of Waste Disposers Inesi.'ataplNumber 'Tons IKW IN n.of Self-Conr,ived Totals: Detee¢on/Alertina Devices No. of Dishwashers 'Space/Arta Heating KW' Local❑Mtmicipal Connection attar No.of Dryers Inciting Appliances KW Security 5 stemsit No. of Water No.of Devices or Equivalent Heaters AW No. of No.of DWata r n Signs Ballasts No.of Devices or No. Hydromassage Bathtubs Wiring:Equivalent No. of Motors Total HP Telecommunications Wiring No.of Devices or Equivalent • Attach additional detail fdesirej or at required by the Inspector of Wires. Estimated Value of Electrical Wont (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rile 10,and upon completion. 1 INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue mkt the licensee provides proof of liability insurance including"completed operation"coverage or it substantial equivalent The c undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE(a 3OND 0 OTHER 0 (Specify.) I certify, under the pains an en s of perjury, that the information on this application is true and complete FIRM NAME: LIC NO.: Licensee: bac. i.( --1-. f;.,_41+ ., Signature 0, ,,t,,,e ,per t. Tic.NO. , Lie. II.S Addresrble, enter"Qempr"in the license number line) . af Bus.Tel.No: A[Alt.LbTeL. No.; 5 j "Per M.G.L. c. 147,s.57-6 ,stew-ivy work requires Department of Public Safety"S"License: No. �c OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage normally O�ed by law. By my signature below,I hereby waive this requirement I ern the(cheek one)❑ owner ID owner's agent Signature - Telephone No. I PERMIT FEE: S