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Home My WebLink AboutBLDE-18-002924 ` Commonwealth of Official Use Only • •V Massachusetts Permit No. BLDE-18-002924 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked )Rev.1/07j 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:11/152017 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 a ctricat w described below . Location(Street&Number) 24 NIAGARA LN [If Owner or Tenant NAGY MICHAEL T Telephone No. Owner's Address NAGY BARBARA,24 NIAGARA LN,WEST YARMOUTH,MA 02673 Is this permit in conjunction with a building permit? Yes ❑ 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement furnace and add NC. 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 ❑ In- o No.of Emergency Lighting grnd. grnd. ,Batten,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 Initiating Devices No.of Ranges No.of Air Cond. 1 TotaloNo.of Alerting Devices 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 0 Municipal ❑ Other: Connection Systems:* s No.of Dryers Heating Appliances KW Security S 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 IIP 1ITelecommunications 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 ❑ 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: Daniel J Peckham Licensee: Daniel J Peckham Signature _ LIC.NO.: 26830 (If applicable,enter"exempt"in the license number line,) Bus.Tel.No.: Address:87 AUDREYS LN,MARSTONS MLS MA 026481629 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:$50.00 (Du , Itgl ( g • r� -- Comer. ai th of r//a5sacLcti5 • 7------TD—Ci OUs e Oln�=n ' PermitNo. lZi 4�. ) 1eoartmcnf f.7ra...(ervks 1/4 VOd FCh '- BOARD OF FIRE PREVENTION REGULATIONS Rev,ccup1/077ancyanPeaveee blank)ecked C� APPLICATION FOR'PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code I C),527 r 12.00 (PLEASE PRINTITIINKORTYPE ALL INFORMgTIONJ Date: —S— City City or Town of: YARMOUTH To the Inspector of Wires: By this application the p designed gives notice of his or her intention to perform the electrical work described below. -- -- Location (Street&Number) a y „1 v tidt in it . Ow -er,5�,.,,T�ner'orTenant 3- r. Telephone Na, a Owner's Address _____________ Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Q z Existing Service !J I Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters _ o n New Service Amps / Volts Overhead❑ Undgrd ❑ .No,of Meters N in a1 Number of Feeders and Ampacity • Ll.w ~ .a Location and Nature of Proposed Electrical Work W Z �� -_ come/e„nn of the foIIow ne table m be waived the Inspector_• et m ., No.of Recessed Luminaires ry �' ofWires. CO a INo.of Ceul�usp.(Paddle)Fags INo,of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tabs Generators • KVA • No. of Luminaires ISimm,ng Pool Above In- O.or N,mergeacy Lighting srad. 0 ernd, 0 (Battery Units No, of Receptacle Outlets !No.of Oil Burners FIRE ALARMS INo,of Zones No. of Switches INo,of Gas Burners No.of Detection and Initiating Devices No. of Ranges Ton INo of Air Cond. No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I'Tons IKW INo,of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Loedl Nluaicipal No. of Dryers Hearin°A I 0 Connection Appliances KW Security Systems; No.of Water No.of Devices or Equivalent • Heaters KWNo.of 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 Attach additional detail tf desired or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by municipal Work to Start � policy.) 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: INSURANCES)BOND 0 OTHER 0 (Specify.) I certify, ander the pains and pens hes ofperjury,that the information on this appEcttf:on is trite and complete, FIRM NAME: LIC,NO,: Licensee:1:4,14.e1-1.?tt, A / Signature A ..�_ (if applicable.enter•'exempt"in the license number Gl e) r+�C per`"' LIC.NO.: [,�f n,L Address: 71 #vcQ lit , Ln. Me,eslb,vs rode." B Alt.TeL No. —�� j Per M.G.L.e. 147, s.57-61,securitywork requires TeL No.: Oso 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. Sy my signature below,I hereby waive this requirement I am the(check one) 0 owner 0 owner's agent u Owner/Agent \� Signature . . Telephone No. . I PERMIT FEE: S