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Home My WebLink AboutBLDE-18-005752 .06 Is* Commonwealth of OfticialUseOnly Is Massachusetts PerrnitNo. BLDE-16-005752 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.!/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 INFORM4TION) - Date:4/17/2018 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) 23 GASLIGHT DR Owner or Tenant GLIVINSKI TAMMY A Telephone No. Owner's Address 23 GASLIGHT DR,YARMOUTH PORT, MA 02675 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repairs to bathroom,bedroom,&kitchen due to water damage. 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 ❑ ln- ❑ 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 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.Ilydromassage Bathtubs No.of Motors Total HP 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 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 P SULLIVAN Licensee: Thomas P Sullivan Signature LTC.NO.: 18182 (If applicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address:71 WAQUOIT RD, COTUIT MA 026353517 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$7100 ( "0(9# Y/f 7f28 ar- gNPIC, Oki) . ./ • Vin f ha e115Official Use Only �, .. mmonwaa e� mdac (t g--$7 5 Z �—= t Permit No. .€sill . cc77 ie� Fapartment o1Jire Serviced "C:444 _44 as Occupancy and Fee Checked p ° ,. 9,a BOARD OF FIRE PREVENTION REGULATIONS [Rev. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 3 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: y/02—/y, City or Town of: flpgjiley0j--)7 To the Inspector of Wires: By this application the unders ed gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) a,3 Gas //nth/- Owner or Tenant Cohen) / Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes EV" No ❑ (Check Appropriate Box) Purpose of Building CafiRUDR ri Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters 'ri`Ol�I New Service Amps / Volts Overhead ElUndgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Qi'p4\rL 6 ^HYre a rn -- J3.<4 2,6fes/ °°°1 a a i L1[ i . .l i. ■ *- • ,4a... - rr,,� 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 --- J1o. of Luminaire Outlets No.of Hot Tubs Generators KVA �_M Above In- No.of Emergency Lighting W m I No.l of Luminaires Swimming Pool Brod. ❑ grnd. ❑ Battery Units N 11VoJ of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones co No.of Detection and of of Switches No.of Gas Burners w .—i �� Initiating Devices Total 1 O a l SIol of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat PumpNumber Tons KW No.of Self-Contained 1L 1 N'of of Waste Disposers �,- Totals: ` Detection/Alerting Devices ' No.of Dishwashers Space/Area Heating KW Local❑ Connis P on Elother uNo.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 AP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work: r (When required by municipal policy.) Work to Start:4C-/4-7 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 B OND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties a ,erjury,that the in ormation on this application is true and complete. FIRM NAME: if - / / I♦ C r' ' I - i LIC.NO.VIVink Licensee: 4 /r,/ / C Signature _��_� LIC.NO. - / (If applicable,enter "exempt"in the license umber 1' Bus.Tel.No: 6 Address: 7/ 6l/477fT/�' ( off Alt Tel.No.: *Per M.G.L.c.147,s.57-61 security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner ❑owner's agent. Owner/AgentPERMIT FEE: $ 7S-- SignatureturaTelephone No.