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Home My WebLink AboutBLDE-19-001306 �,.�� Commonwealth of Official Use Only f Massachusetts Permit No. BLDE-19-001306 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:8/31/2018 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) 10 CYGNET RD Owner or Tenant MORIN ROBERT J Telephone No. Owner's Address MORIN DOREEN M,58 DILLA ST,MILFORD,MA 01757 Is this permit in conjunction with a building permit? Yes ❑ 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: Split NC,washer/dryer,relocate panel,install receptacles,&install ceiling fan. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ Pg 1:1No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatinc Devices No.of Ranges No.of Air Cond. Tota( 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 ❑ Municipal 0 Other: Connection No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water ICY No.of No.of Data Wiring: Heaters Stens 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 ifdesired,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: Jeffrey T Foss Licensee: Jeffrey T Foss Signature LIC.NO.: 36938 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:33 SULLIVAN RD,W YARMOUTH MA 026733543 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:$75.00 ue? t wC Wd4r 3,r 2/ i/'C F (ttser-u, , a 42e.. (se. ..m/y:&u r k m 1-2-boli g ``* I 0'' n/� yy� \ -�- t-ommonmra of///wsas Qi Official Use Only cc�}� cc77 nn \ `lI 1JrParfinrni o�,}irr Jrrvtcis Permit No. '��a • Occupancy and Fee Checked v BOARD OF FIRE PREVENTION REGULATIONS ev. 1/071 " (leave blank) APPLICATION FOR�PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code $7781° (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: o/City or Town of: YARMOUTH To the 1 ctoWires: • By this application the pndersigned _'yes notice of his or her inten'o to perform the elec•'cal work described below. . Location(Street&Nu 'ber) 4 4 ''4 1 AAdAid,tT, Owner'or Tenant /4 j/A 47 Telephone No. I r' 60!/9/g Owner's Address i /)1/,4 5'/r itr , 0175' 7 • Is this permit in conjunction with a building permit? Yes ❑ /No ® (Check Appropriate Box) a Purpose of Building 0 a- Utility Authorization No. I z 0 Existing Service/CU /2� /..2 Volts Overhead Undgrd❑ No.of Meters / New Service Amps / Volts OverheadUndgrdr ❑ No.of Meters i Number of Feeders and Ampacity 0 cation and Nature of Proposed Electrical Work: k (7 IF i it Completion of the following. •ble may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of CeiL Sasp.(Paddle)Fans NTo Total CO m ransformers°f KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swimming Pool Above 0 In- No.of Emergency Lighting p S / g nd. ernd. 0 Battery Units No.of Receptacle Outlets//10544 / No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches t� No.of Gas Burners No.of Detection and Initiating Devices o No.of Ranges No.of Air Cond. Too No.of Alerting Devices • No.of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained Totals:I I Detection/Alertiny Devices No.of Dishwashers Space/Area Heating KW LocalMunicipal ❑ Connection ❑ et Ill?r V No.of Dryers ' Heating Appliances K Vy Security Systems:* V No.of WaterNo.of Devices or Equivalent Heaters No.of o.of N KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: Na.of Devices or Equivalent OTHER: �/ Attach additional detail if desired or as required by the Inspector of Wires. • Estimated Value of I triWorld (When required by municipal policy.) Work to Start: 7?1) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COtERA E: 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 0 OTHER 0 (Specify;) Cgq,ge n,�,,j c b /0 / I certify,under the pains and enaitics of perjury,that the information on this application is true and complete. v le FIRM NAME."—a' LIC.NO.: '• Licensee: f fr \ Th4:5 / ,Signature aa/ waJ/ LIC.NO.:a (If applicable,enter"eze t"' the e e m tie. Bus.Tel.No.. Address. 33 �t//Jt Fi�'?4 11/ty/f ' 0 4 D,r76�3 Sob=716-14 JAlt Tel.No.: 'Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S'•License: Lic.No. K OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally rmally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. t Owner/Agent al Signature Telephone No. I PERMIT FEE: $