HomeMy WebLinkAboutBLDE-18-003624 Commonwealth of OfficialUseonly
oe eMassachusetts Permit No. BLDE-18-003624
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:12/19/2017
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) 200 SOUTH SEA AVE
Owner or Tenant REISMAN PAUL P Telephone No.
Owner's Address REISMAN MARIA,75 JOHNSON RD,SCARSDALE, NY 10583
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 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: rewire hallway stair lights&switches,fish in new hardwire smokes,ground
service(508-398-9011) •
Completion of the following table may be�aMdrii by the Inspector of Wires.
No.of Recessed Luminaires - No.of Ceil:Susp.(Paddle)Fans No.of . Total
Transforms /��_��J KVA —
No.of Luminaire Outlets No.of Hot Tubs Generators <V VA
No.of Luminaires Swimming Pool Above ❑ In- ❑ - No.of Emergency h b
grad. grad. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of ZePePO&,n`1
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-ContainedTotals: Detection/Alerting Devices ceNo.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ [�Connection ll
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 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: MARK H CHASE
Licensee: Mark H Chase Signature LIC.NO.: 8669
(Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:21 DRAKE ST,YARMOUTH PORT MA 026752204 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,f hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. 'PERMIT FEE:$50.00
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Permit No. pLD6 -A7•abm36ay
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BOARD OF FIRE PREVENTION REGULATIONS ev. U07] gen blink)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
MI work to be performed is a cathect whb the Mawchmette Markel Cods(MEC).327 CM*12.00
(PLEASE PRINT!1Y iNK OR TYPE ALL INFORMATION) Data ',IP en '
City at Tan oft YR' I'I To the inspector of Wins:
By this application the undenigned gives narks of his or her intention to perform the electrical work described below.
oaths(Street a Member) a.A O so VA �crt•- ,(,rte f- YA .--'$t
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