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Home My WebLink AboutBLDE-19-003173 i � Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-003173 0BOARD 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:11/21/2018 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) 72 WIANNO RD Owner or Tenant GORSUCH WILLIAM B Telephone No. Owner's Address GORSUCH LYNNE A,72 WIANNO RD,YARMOUTH PORT, MA 02675 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: Install generator. 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 1 KVA 9 No.of Luminaires Swimming Pool Above ❑ In- ❑ 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 Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons _ No.of Waste Disposers Heat Pump Number TonsKW No.of Self-Contained Totals: I 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: jNo.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: SEAN C ROGAN Licensee: Sean C Rogan _ Signature LIC.NO.: 20141 (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: Address:30 MELIX AVE. PLYMOUTH MA 023601280 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 `' _.,�a l.ommonara Olt t r/aesac/ue4all!11: ,s� Use Only y'= B {..e.Jaroius 'e-C7-7v I �' 3 a1 aParlmst�o Pert No. !IE_ Occupancy and Fee Checked • lPo7] • (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1200 (PLEASE PRINT ININKORTYPE ALL INFORMATION) Date: !l/V/le City or Town of: YARMOUTH To the Inspector of Wires: By this application the imdersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 72 WIAA?0 /',.i, j0 Owneror Tenant &spy ocrS `7 Telephone No. Owner's Address ---� sow ________-;---4t- is permit in conjunction with a building permit? Yes 0 No (Check Appropriate Box) /] 1.1'uctiupose of Building /74/t/ll[tl Utility Authorization No. jN rt1 ting Service Amps , / Volts Overhead ❑ Undgrd❑ No.of Meters __ �Qe Service Amps / Volts Overhead 0 Und .` grd❑ No.of Meters �u ber of Feeders and Ampacity VJon and Nture of Proposed Electrical Work: 1 /fit✓ cene . Pr 44 4 efrvif11l ❑ It • •le ion o the ollowin_ table m• be waived• the! . fora Wires. o.. f Recessed Luminaires No.of Ca -Snsp.(Paddle)Fans 'o•of To Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swimming pool Above ❑ d. 0 BIn. No.atteryof I'.mergencyUnits upon - ¢rud. No.of Receptacle Outlets No.of Oil Burners - FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and ' • • Initiatntt<Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat PumpNumber Tons W No.of Self-Contained - Totals:I I KDetection/Alerting Devices No.of Dishwashers Space/Area HeatingKWMunal ' Low❑Connection 0 °th? No.of Dryers Heating Appliances KVV Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters 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 - Attach additions/detail jdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by municipal policy.) Work to Start //J21/'/t 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 cove is in force,and has exhibited proof of same to the permit issuing office.ONE: INSURANCE C'7 BOND 0 OTHER 0 (Specify.) I cent)", under the pains and penalties of perjury,that the information on%plication is true and complete. LicFIensee: AME: SCfe C/ecVt I;C LIC.NO.: .42J=_ Sr`e em the✓ Signature LIC.NO.: SE / (If applicable,enter"exempt"in the license number line) Tel.No.. gni Address 30 /17e6i tatit-frMot/It MG 0230'Per M.G.L.c. 147,s.57-61,security1 jwork requiresAlt Tel.No.: Department of Public Safety"S"License: Lie.No. �c 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 enc t Owner/Agentg Signature Telephone No. I PERMIT FEE: $ 5