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Home My WebLink AboutE-19-2261 • Commonwealth of oftoialUseonly 'E Massachusetts Permit No. BLDE-19-002261 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:10/17/2018 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) 122 OLD MAIN ST _ Owner or Tenant COOPER MARTHA B TR Telephone No. Owner's Address C/O PETER B COOPER, 122 OLD MAIN ST, BASS RIVER, MA 02664-4524 Is this permit in conjunction with a building permit? Yes 0 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Septic pump&alarm.Re-feed garage. 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- 1:1No.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 1 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 KW No.of No.of Data Wiring: Heaters _Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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: Jeffrey T Foss Licensee: Jeffrey T Foss Signature LIC.NO.: 36938 (if applicable,enter"exempt"in the license number line) Bus.Tel.No.: Address:33 SULLIVAN RD,W YARMOUTH MA 026733543 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 �3 14((86C _- . \ l.Ommor..tveaS of Ma3lec aftt • rmOf cial Use Only � rt'`7� c7 ie vn �I� c 2cparlmcnt o{-lira J Permit No. _ eea __ ` WL ____ VSOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07) . --� peke blank APPLICATION FOR.PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacbuseus Electrical Code(MEC), . 7 12." (PLEASE PRINT MIINK ORTYPE ALL INFORM/1270N) Date: 0 I 0 City or Town of: YARVIOUTH To the Inspecter of tires: By this application the undersigned;rives notice of or her intent a�ttoperform the electrical work describedd bellow • Location (Street&Number) /7& 0 A �( s fiY UUT/jc Owner'orTenant tf ,r,' COCienteTelephone No. Owner's Address 5/*/#1r. __________ _ Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building Utility Au ciliation No, Existing Service!d 0 Amps �a40 / Volts Overhead,, Undgrd❑ No.of Meters New Service ❑ Undgrd !11 00 �i Amps / Volts Overhead ❑ No.of Meters >iN ! Number of Feeders and Ampacity cfl I Location and Nature of Proposed Electrical Work: 14 e '! G / ✓ i 1, i di WI - I fl/t' tri U v - S�S�'� �r U/U (J„ � If/�jlC' T/I ,/ ' _% _.. �/1� .�..� fie A,1- ^-t\I Completion of the following table may be waived Sy the Inspector of Wires. uJ I V' No.of Recessed Luminaires INo,of Cel Snsp.(Paddle)Fags 'Na.of Total l C�----f:�, �,r Transformers KVA • jtJ No. ofLumiaait-eOutlets INo.rofHot Tubs (aerators I�'VA No.of Luminaires ISR'Jmm*ng root Above ❑ In- No.of emergency Lrghung - . grad. ern d. 0IBateergUnb No. of Receptacle Outlets I r No.of OB Burners FIRE ALARMS INo.of Zones No.of Switches �No, ecna nd — No.of Gas Burners of DInitiatinet =oDevicaes No.of Ranges INo.of Air Cond. Tons Total No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW INo.of Self-Contained Totals: Detection/Alertine Devices 0 No.of Dishwashers Space/Area Heating KW' Local❑Municipal Connection o Oda No.of Dryers 'Heating Appliances KW Security Systems:• No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wein Signs Ballasts No.of Devices or Eqguivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent oliiiR _ • Attach additional detail 9'desired or as required by the Inspector of Wires. Estimated Value of El ..'c Wor)` (When required by municipal policy.) \�� Work to Start Q 6 C p p cy) INSURANCEtCO _ ♦ Inspections to be requested in accordance with MEC Rule 10,and upon completion. ' : 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. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing under the paint and office. i CHECK ONE: INSURANCE �.q p � I certify "eh�tdBOND ❑ OTHER 0 (Specify) -(// G�(tG �'d �(j lDI I p fperlw3,that the information on this appltctttfon is true and complete. ibi FIRM NAME: LIC.NO.: Licensee: I/ f / Signature /� �� t ' y4j LIGNO.: 1j (If apdrlicable, a "exam, ••! !to- a bar line. RE ` Bus.t TeL No.:; Address 1 `+� s al �� O [i j `Per M.O.L.C. 147, s. 5 -6l,securitywork requiresAlt TeL No.: v Depat�trnt of Public Safety"S" ieense: Lic.No. •.,7t 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 arc the(check one)0 owner ownl lent. t Owner/Agent al Signature Telephone No. I PERMIT FEE: $ 'b