BLDE-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
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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