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HomeMy WebLinkAboutBLDE-19-003791 Commonwealth of Official Use Only FE_ '" Massachusetts Permit No. BLDE-19-003791 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:12/26/2018 City or Town of: YARMOUTH ' To the Inspector of Wires: By this application the undersigned gives notice of his or her mtention to pertorm the electrical worblescribedtbelovy'' //7 �� Q Location(Street&Number) 16 HORSE POND RD ti-- //// Owner or Tenant JOHN FALLON Telephone No. Owner's Address 18 HORSE POND RD,WEST YARMOUTH, MA 02673 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: Gas fireplace(774-208-8338) 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- 13No.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 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water K1V 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 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: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (Ifapplicable,enter"exempt"in the license number line.) Bus.TeL No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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 — ' ya Q/ j = Comma..anava&of Manacixwrtie Official Use Only . t94 -_-� JJrPartmrnt al �irr ServicesPermitNo. Sae/5 d D 3n/ �I� • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. I/O (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRIC ••L WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), ,27 r 2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: g'6 f City or Town of: YARMOUTH To the Inspecto of Wi es: By this application the undersigned giv otice of his, her''t j n to rform the electri . work described below. • . Location(Street&Number) ., t t1 t ' 04 A ©a6 Owner'orTenant ~co 4 Telephone No. Owner's Address , Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Boz) m Purpose of Building Utility Authorization No. .0; Existing Service_ Amps / Volts Overhead 0 Undgrd o ''New Service ❑ No.of Meters Amps / Volts Overhead❑ Undgrd ❑ No.of Meters '= , .. E Number of Feeders and Ampacity ,k Location an ature of Propos Electric I Wo k: L/ ' r I 44 1 / `r `e d 'r cad epee CLe or JT(' 9/y� / '�ti / �/ CompletanlO e fo awtn e may be waived by the Inspector of Wirer. -^ No.of Recessed Luminaires Na,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- No,of Emergency Lighting grad. ❑ orad. 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. Ton 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' Muni Local❑ Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KN No.of 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 ifdesired or as required try the Inspector of Wires. Estimated Value of Electrical Worki (When required by municipal policy.) Work to Start: 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 iti 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: / i LIC.NO.: Licensee: _, Lrr �in Signature / / I r a Ay (Ifapplicabl- enter';esenlp 'in the lit -e nu b- line)�i• �� Tel No.: . E/ Address. . .LI_ VTR ger),/ if / • / „q Bus.TeL No.: !vj o j� j `Per M.O.L.c. 147,s.5 -1i,security work requires D ant o Public SafetyAlt Tel.No.: Dep "S"License: Lie.No. Q OWNER'S INSURANCE WAIVER: I am aware that a Licensee does not have the liability insurance coverage normally ic required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $