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Home My WebLink AboutBLDE-18-002277 d t`�` Commonwealth of Official Use Only ® Massachusetts Permit No. BLDE-18-002277 / BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/071 • 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:10/17/2017 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 b --,-- Location(Street&Number) 1214 GREAT ISLAND RD n3/p.�. /� ,21 Owner or Tenant SALTONSTALL THOMAS B Telephone No. Owner's Address C/0 ELIZABETH Z CHACE,46 ABORN ST 4TH FLOOR, PROVIDENCE,RI 02903 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: Wring of detached garage. 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- ElNo.of Emergency Lighting grnd. Rrnd. Battery Units No.of Receptacle Outlets 4 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 4 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 Pleat 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 Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total lIP Telecommunications Wiring: No.of Devices or Equivalent OTIIER: 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: JAY A DONNELLY Licensee: Jay A Donnelly Signature LIC.NO.: 15717 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:158 PINE ST, RAYNHAM MA 027671121 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. J PERMIT FEE:$75.00 RSA C IOrfeh 7 "Ny4L illyy/i6 C�� j- o,JW ✓ - l.ommorswealg of//taziae�e. eche Use Onl 2 t:, c� -/2e? tte of.,ireNo. • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS •ev. 1/07] ' (lczve blank) ----- 1 APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1200 (PLEASE PRINTININKORTYPE ALL INFORIIATION) Date.lp I City or Town of: YARMOUTH By this application the ers ed m the Inspector of Wires: es; pnd gives notice of his or bei intention to perform the electrical work described below. o —{;p I,'f Location (Street&Nnmber)/&/V&�r7—z5-,, ,2.0 Owner'or Tenant 1, /40;`J Ii /f��j s7j /J`r Telephone No. > s'=.t Owner's Addresb22Sy 2' /2.0,67o4g ST&�J�� ,OD.S�LU,nog-. . u ��( Is this permit in conjunction with a *>�1building permit? Yes No ❑ (Check Appropriate Box) U t— , Purpose of Building�j4,17t /�r UtIIity Authorization No, ui t i- Existing Service Amps / Volts Overhead ,, m�—_ ; c T ❑ Undgrd❑ No. of Meters _ 'a , New Service Amps / Volts Overhead Und>rd ❑ ❑ Nt, of Meters ___!Number of Feeders and 4mpsc ty Location and Nature of Proposed Electrical Work-. 7- iti_4-7,<,, a0x • D7cHED rem( Hays>c �,�r2 eenTh /fous< - - Completion of the following.table may be waived by the Inspector ofWa-es. No.of Recessed Luminaires No.of Ceti-Srsp.(Paddle)Fans INo.of Total Transformers KVA No. of Luminaire Outlets No.rof Hot Tubs [Generators • KVA ' No.of Luminaires /� Swi`rt+ming pool Above ri In- 0 No.of Emergency Lighting - �'// end. arnd. IBattery l7a-its No. of Receptacle Outlets y No.of Oil Barriers YFIRE ASAILMS IND.of Zones No. of Switches No.of Gas Burners No.of Detection and -� • Initiating Devices No. of Ranges No.of Air Cond. Total tons No.of Alerting Devices • Heat Pump Nnmber Tons KW fNo,of Self-Contained Totals:I I I lDetection/AlerE Devi No.of Waste DisposerstinDevices No, of Dishwashers Space/Area Heating KW IT-kcal❑ Municipal No.of Dryers I Connection 0 er r9 (Heating Appliances Kart SecuritySystems:t No. of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring — Signs Ballasts No.of Devices or Equivalent No, Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: k No,of Devices or Equivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work bo Work to Start (When required by municipal 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 c,o�v`�a is in force,and has exhibited proof of same to the permit issuing office. E CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify-3 t I cerm4fy, under the pains andpenalties of p��,that the information on this appftcaiion is true and complete FIRM NAME: `j'"/� /�/ . t �Q/tJ/(1F��C-�FCT/?Sr"j L LIC.NO.: k. Licensee: f) jU��iSignature B LIG NO.: �d ( ff �/ (1faPPltmble,grater 'a.,,t"in the titian cru •er f' a 4 � . Address: / Bus.TeL No./r j'/�� I 7 :Ca' 4 e MI . 4 Alt TeL No • •. t_ j Per M.G.L.c. 147,s.57-61,security work requires D .. ent of Public Safety F' �Gt.�, ep- ety"S"License: Lie.No. tc OWNER'S INSURANCE WArVER I am aware that the Licensee does not have the liability insurance coverage horn elly S Owner/AgentrequirBy my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent JSignature . . Telephone No. I PERMIT FEE: $