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Home My WebLink AboutBLDE-19-002842 Commonwealth of Official Use Only L, Massachusetts Permit No. BLDE-19-002842 �-'� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.1/07] 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:11/8/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. . Location(Street&Number) 29 SCALLOP RD Owner or Tenant CHLECK FAMILY FOUNDATION INC Telephone No. Owner's Address C/O CHLECK DAVID,254 VILLAGE BLVD#4103,TEQUESTA, FL 33469 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 ❑ 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: Grounding 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- ❑ No.of Emergency Lighting rind. rind. 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 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 Total HP 'Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail rfdesired.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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: DAVID BALFOUR Licensee: DAVID BALFOUR Signature LIC.NO.: 22363 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 14 STARBOARD DR, MASHPEE MA 02649 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:$50.00 656 9_ il ( i-stie ba, V ,) . ,mmo,,... ofe/r/...achaEEs Official Usee On �7 . 11,_. .[JrParLnenE o�Jirs J Permit No.�� ' LCJ�C/ a arum! ) • BOARD OF FIRE PREVENTION REGULATIONS O Occupancy and Fee Checked . 1/07] . (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12.00 Iz I LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g w �' I City or Town of: YARMOUTH To the I>tspe�or 6f Fires: R is y this application the;rid ersigned gives notice of his or her' tention to ;the etectrical work described below. • W tw cation(Street&Number) 9 S ,44—_ k. I C18\) O wnerbrTenant g �S` Telephone No. '9 ttc C� 1-.iwines Address �o n •"' 15 s this permit in conjunction with a buildingpermit? -F� � 7 751'3')P purpose ofBuildingnco � Yes VNo 0 (Check Appropriate Box) Oar? I slip a//Costrip J.( CC Utility Authorization No. �` Existing Service Amps / Volts Overhead ❑ Und grd❑ No.of Meters _ (� New Service Amps / Volts Overhead 0 Und grd ❑ No.of Meters "1 m Nuber of Feeders and Ampacity tl(2E tl ,SU FEC' 1_ . Location and.Nature of Proposed Electrical Work: a of (.• J c m.-7 r�tie] !a a lis c � lcieEc' f ti f) LCGPt tl err - zres. ee Completion ojthefo[!ow[rtLtab a may be waived by the Inspector ojll"ves. No.of Recessed Luminaires No.oCCed.-Snsp.(Paddle)Fans • No.of Total Transformers ICVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swtmmtag pool Above In_ No.ofinergency Lighting — ernd. ❑ erred. ❑ Battery Units No.of Receptacle Outlets No.of On Burners FIRE ALARMS INo.of Zones No,of Switches No.of Gas Burners • No.of Detection and • Initiatfne Devices Total No.of Ranges No. of Air Cored. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number ITons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Leal ❑Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* — No.of Water No.of No.of Devices or Equivalent No.of Heaters l< '' Signs Ballasts Data Wiring No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 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 lectri al Wo (When required by municipal policy.) Work to startII 12�� Iec ons be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VEFYAGE: 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 coves s in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEBOND 0 OTHER ❑ (Specify:) f certify,under the pains and penalties ofperfu •,that the inform:tido on this application is true and complete. FIRM NAME: (no d, C Licensee: a� Signature �� 1� af gn �s�r� IC.NO.: _ Licensee: e,en-; " empt' int !i rise numb�l[n: Address. Y9 �/ J O'a iS. (/a/441J0/1 ' Bas.Tel.No: j *Per M.G.L.e. 147,s.57-61,security work requires D artmcd`tt of Public SafetyAIt Tel,No. 53517 eP "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. By my signature { below,I hereby waive this requirement I am the(check one)0 owner 0 owner's a,ent i Owner/AgentV', j Signature Telephone No. 1 PERMIT FEE: S