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Home My WebLink AboutBLDE-19-003742 W r Commonwealth of Official Use Only '4 A`n Massachusetts Permit No. BLDE-19-003742 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.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:12/20/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice or his or her intention to perform the cicctricarwork described below. Location(Street&Number) 86 COTTAGE DR Owner or Tenant BLOOMER JOHN Telephone No. Owner's Address BLOOMER ROBIN,5 TIFFANY TRAIL,HOPKINTON, MA 01748 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Septic pump&alarm 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 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 1 Totals: Detection/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water 1CW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring: No.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 periury,that the information on this application is true and complete. FIRM NAME: Michael F Simonis Licensee: Michael F Simonis Signature LIC.NO.: 16862 (7f applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 1488,EAST DENNIS MA 026411488 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:$50.00 :4 J yy �q.� 1�J _ amino.Thapa.. of mac ssifs ffilcial Use Only ' e rfmane oil gut Permit No. L` 7j Sided Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 7tev. 1/0 APPLICATION FORPERMIT TO PERFORM ELECTvRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME9,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: /? er r� 1 City or Town of: YARMOUTH To the Inspector o Wires: 0 - I$y jhts application the undersigned gives notice of his or her intention to perform the electrical work described below. cc, , o tion(Street&Number) �/o '�+_. ciao" ;v o .r cj -e l��i v -r �' OWteforTenant Telephone No. I c��r pw-rer's Address I L i_s ' permit in conjunction with a building permit? Yes 0 Na �-�,/ (J (Check Lu ! // Appropriate Box) l u ose of Building.2rp/-C %�,,.._c = `� Utility Authorization No. fl, Lzisting Service_ Amps / Volts Overhead 0 Undgrd❑ No.of Meters _ New Service _ Amps / Volts Overhead❑ Undgrd gt ❑ No.of Meters Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work; Gert/ ,F `✓ .r� S c�r< P✓.,P1L ne;9 4 Completion of the followinvable may be waived by the Inspector of Wires. No.of Recessed Luminaires Na,oCCet1-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- No.ol"hmergency Lighting ern ?rnd 0 Battery Units No.of Receptacle Outlets . No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number (Tons I KW No.of Self-Contained - Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW In'0 Municipal Connection °th!en No.of Dryers Heating Appliances KW Security Systems:* - No,of Devices or Equivalent No.of Water No.of Heaters KH' No.of Data Wiring; Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical WorE Attach additional detail if desired or as required by the Inspector of Wirer. Workm t 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ErEIOND ❑ OTHER ❑ (Specify:)'7,t-4✓e.//-e r s I certify, under the pains and penalties of perjuzy,that the information on this application is true and complete. 5 med.,:NAME: med.,: .s .4.7/2--2.--712--c r.---.c. NO.. , ,fix-rGt?i c Licensee: ae--14.e/ „Si en_.0-.., es Signator IC.NO.: C goal (Ifapplicable,enter"exempt"in the license number line.) - ��ze�- - - 8 Address: i� '. /3O)c /107'e T be— S res — Bus.Tel.No _ SaA-88g_$68�. of Public SafetyAlt Tel.No: J Per M.G.L.c. 147,s.57-61,security work requires Department — "S"License: Lie.No. —�- - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n — required by law. By my signature below,I hereby waive this requirement I am the(check one)❑owner 0 owner's agent. t Owner/Agent 3 Signature Telephone No. I PERMIT FEE: $ 4.57)-°vI