The URL can be used to link to this page

Home My WebLink AboutBLDE-19-000272 • ` Ok Commonwealth of Official Use Only ital Massachusetts Permit No. BLDE-19-000272 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:7/12/2018 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. ��p / / -�!�.� Location(Street&Number) 258 HIGGINS CROWELL RD 7 `6" tDi ' evzz, Owner or Tenant RUSSELL DENISE M Telephone No. Owner's Address 258 HIGGINS CROWELL 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: Replacement boiler Completion of the following table may be waived by the Inspector of Wires.i No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans iNo.of Total ,_, Transformers KVA No.of Luminaire Outlets No.of Hot Tubs I Generators KVA No.of Luminaires Swimming Pool Above ❑ ln- a 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 Initiatine 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 Heating Appliances KW Security Systems:* 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 HPTelecommunications Wiring: iNo.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: JOHN WEISS Licensee: JOHN WEISS Signature LIC.NO.: 53846 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:63 UNCLE BOBS WAY,SOUTH DENNIS MA 02660 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 I�¢ 10/zwlle � A ,%/fe se ) 10[31 I& Kt" . . emimotunat o f ttlaaeac its sin 'al Use Only _ � ccyy� c7 �(7s U 9 -o27z ��€ 1Jepartmeat of-yin Jennie. Permit No. -!I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07) . (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(I/EC) CMR 12.00 (FLEASEP RINT WINK OR TYPE ALL INF, ' •TION) Date: 2 /Z. /cr.— City or Town of: • ' I i-i TH To the Inspector of Wires: CI . By-this application the]orders:an d giv _otice of his or her intention to perform the electrical work described below. /wf . bullion (Street&Number) , . ,r�eytJrr / �� - e/> r t a� Owi er or Tenant C.. �� // ,� C73 �— �� ' � Tel hone No.________ .$2'071; �.. `-' (awher's Address 85 Hi .7 r (T,roe✓CII f}} fit/. i1J�2 ft1 15 fits permit in conjunction with a Tiding permit? yes ❑ No V \� ICP4�pose of Building ❑ (Check Appropriate Box) ExI( Utility Authorization No. isting Service Amps / Volts Overhead❑ Und Nil, god❑ No.of Meters m N w Serviee Amps / Volts Overhead 0 Undgrd 0 No.of Meters �` Nrimber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i ler RRec� .er Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cert Snsp.(Paddle)Fans No.of Total Trsnsformers KVA — No.of Luminaire Outlets No.of Hot Tubs r Generators KVA No.of Luminaires Swimming Pool Above ❑ !n- No.ottmergency Lighting gond. gond. 0 Battery Units No.of Receptacle Outlets No.of OH Burners FIRE ALARMS 1No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Coml. Total on No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local 0 Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW 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: y - Estimated Valu t ca otk //`r Attach additional detail ijdesiree(or as required by the Inspector of Wirer. / V 1 (When required by municipal policy.) Work to Startl Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 0 OTHER 0 (Specify:) I certify,under the pains and penalties ofperjury,/ that the information on this application is true and complete. FIRM NAME: l it er..), fE/ecTr/,f/al LTC:NO.: s3t/QP ' 5 Licensee: ( ovw f Signature �,( LIC.NO.:2 ,44 (Ijapplicable,enter"exempt' in he license number line) T Bus.Tel.No. 3'? ;Y/, Addresr, n.3 cas0 r / .o 5 c f.Ve,th. Alt.Tel.No.: j Per M.G.L.c. 147,s.57-61,security work rAuires Department of Public Safety"S"License: Lic.No. Q 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 t Owner/Agentg j Signature Telephone No. I PERMIT FEE:$ 1