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Home My WebLink AboutBLDE-19-003430 1 kiCommonwealth of Official Use Only a Massachusetts Permit No. BLDE-19-003430 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:12/5/201 S 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) 7 STRATFORD LN Owner or Tenant STEADMAN WINSTON A II Telephone No. Owner's Address OCONNELL-STEADMAN ELEANOR J,7 STRATFORD LN,YARMOUTH PORT,MA 02675 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 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: Receptacle for water heater and gas insert. 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 0 In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 2 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 ❑ 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 if desired,or as required by the Inspector ofWires. 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:) /certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature _ _ LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 oteS,Q_ i %á5 a s. \" t-ommonmsa of tr/aesac�CusrEfs Official Use On 't,�n t \ c� cc77� n1 --.JI �� apartment of firs J LPermit No.�q' -- Iervfcet1I� cupancy and Fee Checked 770-e) BOARD OF FIRE PREVENTION REGULATIONS . Iro7] (have 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: 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. • Oer Q • Z .cation(Street&Number) 1. Si•¢e .k-Cor $ Lowe— t uO er'orTenant (J .�S(oN t1' • p set NI ' Meaner- S � Telephone No. Sb8 ¢FG �( l�d er's Address $0H'-t. �� 9 — o ' a_ Is this permit in conjunction with a building permit? Yes 0 No ® (Check Appropriate Box) l rpose of Building •" Jo 1 UtilityAuthotizstionNo l ti j o ng Service {06 Amps 4O / $ ( Volts Overhead ❑ Und d La I gr No,of Meters / New Service _ Amps / Volts Overhead❑ Undgrd II >T 0 No.of Meters -- "LI Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work. ()La Lair (Kyr•. Gw.S tms.kkr Jk#kR. F Sea-T ,rep/atL Completion of thefollcnvingyable may be waived by the Impactor of Wirer. No.of Recessed Luminaires No.of CeB.-Susp.(Paddle)Fant No.of Total Transformers lCVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abod. crud. Bave 0 In- No.oftteryUEmniergencyts Lighting Bra No. of Receptacle Outlets No.of OH Burners FIRE ALARMS INo.of Zones No.of Detection and - No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Ton No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local Mnnlcipal 0 Connection 0 Omer No.of Dryers Heating Appliances V Security Systems:t No.of Water No.of No.of Devices or Equivalent No.of Heaters Data Wiring Et Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: fV*f OTHER No.of Devices or Equivalent c� c se Attach addition(detail if desirec( or as required by the Inspector of Wirer. 2II Estimated Value of Electrical Work av0 (When required by anmicipal policy.) O Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 4 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 r 2 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 comp fete. FIRM NAME: /j-nwe, per_ vi Licensee: LIC.NO.:_________ �'- 3 LIC.NO.: (ljapplicable,enter"exempt"in the license number line.) Bus.Tel.No.:_ o_ cab},( Address: 9 'Pet M.G.L.c. 147,s.57-61,security work requiresAlt.Tel.No.:�_ 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 crequired by la �g my si a e below,I hereby waive this requirement. I am the(check one) i.1 owner 0 owner's agent. Owner/Agent % i Signature Telephone No. 508 Zs 6.a/71PERMIT FEE: S