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Home My WebLink AboutBLDE-18-002918 '41140 Commonwealth ofOfficial Use Only Massachusetts Permit No. BLDE-18-002918 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked tRev.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:11/15/2017 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 despryb5Ebelow. Location(Street&Number) 166 WINSLOW GRAY RD KK i5 ��- I—� Owner or Tenant HENDERSON BARBARA Telephone No. Owner's Address 166 WINSLOW GRAY RD,WEST YARMOUTH,MA 02673 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: Add lights&receptacles. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 13 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- 0 No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 16 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Imtiatine Devices No.of Ranges No.of Air Cond. ,Tl.00tal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 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.Yo.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent No.Ilydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: - Attach additional detail fdesired,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. (017- 8 3 ^ �-'1 3 CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) l J I I certify,under the pains and penalties of perjury,that the Information on this application Is true and complete. FIRM NAME: ANDREW G THOMAS Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 ECHO LN,CHATHAM MA 02633 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: $75.00 it ((Lear) 2J-4,6 Ft.tf at___ t o f I I a rte _ l-om mnrruea g of Ma6dac a . ' Oi-i'icial Use Only_ • 1- aparlmenf a{Jiro-Serviced Permit No. • Occupancy and Fee Cnecked �� BOARD OF FIRE PREVENTION REGULATIONS i • v. 1/073 . (leave blank APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK .All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MAR I2.DO (PLEASE PRINT IN INK OR TYPE ALL INFORMA770 M Date: N01/ 15-, 1ol2 City or Town of: yARMOUTH To the Inspector of ryes: . By this application the undersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) I (et. • Iu,h S&ol' &fat, ik.6;i l Owner•orTenant StIfutt, C04i q/. S Telephone No. �l7– Owner's Address 1 h 4 t t–..sit. "t tack) (oad QIs this permit in conjunction with a building permit? Yes No 0 (CheckAppropristeBoz) Purpose of Buildingnt% dtnj i it( Utility Authorization No. 0 , i Existing Service 10b Amps U 0 /d4 h Volts Overhead& Undgrd I W w ❑ No.of Meters 2 New Service > o Amps / Volts Overhead❑ Undgrd 0 No. of Meters nN a Number of Feeders and 4mpscity • "-'� w I Location and Nature of Proposed Electrical Wort. tr,144a7 Vann! i, tit U h_ h; bf4ri,;1 cxtTltiS W A �� C7 p Z I _ _ _ Iii II O Completion of the following,table may be waived by the Inspector of wr , '' No.of Recessed LuminairesNo.of KVA CC o ->, )� INa.of Cefl.�Sasp.(Paddle)Fans •No.of � Total No. of Luminaire Outlets A INo.of Hot Tnhs Generators • (CVA ' No. of Luminaires ISwimss,ing Pool Above ❑ in.- IBNo.ox L+mergency Lighting - =rid. arid- atterp Units No. of Receptacle Outlets D 0 No. of Oil Barners �• �ALARMS INo, of Zones No. of Switches No.of Gas BurnersNa.of Detection and Initiating Devices No.of Ranges INo.of Air Cond. Total Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number (Tons IKW Na.of Self-Contaimed Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating ICW Local ❑Connection 0 Other No.of Dryers (Heating Appliances KW Security Systems:* No. of Water No.of Devices or Equivalent Heaters KW No. of No.of Data Wiring: Sins Ballasts No.of Devices or Equivalent No. Hydromassage Bathtobs No. of Motors Total HP Telecommunications Wiring; OTHER: ^ • No.of Devices or Equivalent _ A+a ,k14,,,,, ncbat•ts Ff.nut1 16 Dthtt$ . Attach additional detail f desired or ar required by the Inspector of Eves. Estimated Value of Electrical World 16 td 0 (When required by municipal policy.) Work to Start lVt,L it j,U 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",] BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and pennkies of perjury,that the information on this application is true and complete. FIRM NAME: IL,as Eleure41 iStevbtif lt•tit LTC-NO.:Z11So1-4 _________Licensee Anlrtu T ct Signature (° ,/l �� LIC.NO.: of applicable, enter"exempt"in the license number line.) Address: 7 eCtl. tate C114i�Prt /y4 62 {,7) Bus.TeLNo.• J `Per M.G.L.c. 147,s.57-61,securi work Alt LbT . No..: .------- j requires Depar�rnt of Public Safety"S"License: Lk.No. ----------- <i OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below, I hereby waive this requirement I am the(check one)0 owner 0 owner's agent , Owner/Agent 01 Signature Telephone No. PERMIT FEE: $