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Home My WebLink AboutBLDE-19-002063 1 ./ a Commonwealth of I Official Use Only 4..471% Massachusetts Permit No. BLDE-19-002063 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:10/9/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of nis or her intention to perform the electrical work described below. Location(Street&Number) 42 JOSHUA BAKER RD Owner or Tenant WOODWORTH SANDRA J TR Telephone No. Owner's Address JOSHUA BAKER RD RLTY TRUST,21 TUTTLE ST,SAUGUS,MA 01906 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 ❑ 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: Remodel kitchen 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.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail(£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 LIC.NO.: 18182 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:71 WAOUOIT RD,COTUIT MA 026353517 Alt.Tel.No.: *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"5"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 SIA 0t47EE EirAM0 `41094 - Oote Co/'fo(ee eg- r'r ' l.ommonweaUt o/ aeeachusella Official Use Only ,iii Et cc�� ec// n Permit No. lU�t).( 7"!Y1 CP V., tike 5 T eearlmenl o/Jire Services �,. .l 1 j Occupancy and Fee Checked —,,< BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) 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: i U -:C --f City or Town of: 'la_r Wtv(A- To the Inspector of Wires: By this application the undersigned gives not/ce of his or her intention to perform the electrical work described below. Location(Street&Number)� ya -d Ji i- fz u Ker Owner or Tenant ..yv/ dr 00 C 0 p/�/� Telephone No. Owner's Address 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❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity jL)� Location and Nature of Proposed Electrical Work: Ke�R)1 j` .Y11^'t.e) otelk 7 Completion of the follawinztable may be waived by the Inspector of Wires. No.ovRecessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA W.,o Luminaire Outlets No.of Hot Tubs Generators KVA W noc. �{t 'l�`o Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting gmd. grnd. Battery Units ll1 .4.1-1-0 No o Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones N_1' No.of Detection and ,— N o Switches No.of Gas Burners V v Initiating Devices W �p NaIo Ranges No.of Air Cond. Total No.of Alerting Devices NdPo' Waste Disposers ns Heat Pump Number Tons KW No.of Self-Contained I Et p Totals: —" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mounnnecticipalion 0 Other C 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 Total IIP Telecommunications Wirin : No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2 STJD (When required by municipal policy.) Work to Start:/p -y-/e 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 EW BOND 0 OTHER 0 (Specify:) I certify,under the he pains and penalties of perjury,that the information on this a plication is true and complete. FIRM NAME: ---7-6147O/L/(/a/0 S'/ec42(�'. �;Z a LIC.NO.: /9/17(p 2 Licensee: -j'dm conMine' Signature /Li t0. ear; LIC.NO.::=,?,/C// (Ifapplicable,enter"exempt"in the license number fir") �J Bus.Tel.No: Add ress: '7/ War Urn r citi( , &i(' M Alt Tel.No.: n7$O-Sz.✓6 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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)❑owner 0 owner's agent. Owner/AgentPERMIT FEE:$ ?5" SignatureturaTelephone No.