HomeMy WebLinkAboutE-18-1347 Commonwealth of OfficialUse Only
Massachusetts Permit No. BLDE-18-001347
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
I[Rev.I/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:9/8/2017
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 45 CONSERVATION DR
Owner or Tenant MAC a; - •M D Telephone No.
Owner's Address C/a COTA GARY LLEN,45 CONSERVATION DR,YARMOUTH PORT,MA 02675-1 18
Is this permit in conjun tion with a buildin_ permit? Yes 0 No 0 (Check ArA'ate Box)
Purpose of Building Utility Authorization No. /\
Existing Service Amps Volts Overhead 0 Undgrd 0 .. i
New Service Amps Volts Overhead 0 Undgrd 0 �J t w
Number of Feeders and Ampacity a b I r
Location and Nature of Proposed Electrical Work: Upgrade existing lights and receptacles.
0 0
Completion of the following table may be wa,.t b i .•ctor of Wires.
No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddie)Fans No.of Transformers ft Ii' A
No.of Luminaire Outlets 6 No.of Hot Tubs Generators i8 VA
No.of Luminaires Swimming Pool Above ❑ In- 0
No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 16 No.of Oil Burners FIRE ALARMS No.of Zones 2
No.of Switches 12 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges 1 No.of Air Cond. 4 .Tl,00tal No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers 1 Space/Area Heating KW Local 0 Municipal 0 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 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 ❑ OTHER 0 (Specify:)
I 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
4� r u ff / vA-iL 4 rf I f (piSe0- ehitt Rs (ZEJ ro' (9Alb - Pl - /
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�' � '. cp „t n/lir.Scndcee •- Permit No. r
1 . �= ' ! Oceapeney and Fee Checked
BOARD OF ARE PREVENTION REGULATIONS by. 1/073 ' pczvebl�at)
APPLICATION FOR.PERMIT TO PERFORM ELECTRICAL WORK
All work to be pilin wed in accordance with the Massachusetts Electrical Code(MEC),527 • 1200
(PLEASE PRINT DV INK OR TYPE ALLDNTORM4TION) Date: / 7
City or Town of: YARMOUTH To the Inspe,for o Wires:
•4
� . By this application the pndertped gives notice of his or her intention to pertbrm the electrical work described below.
ID Location(Street&Number) qg co.2,sEn(Amok' pie. y.421Vetflmm 'Pier
0..__..—,x-10 veer orTensat (, i(Y 1 eo � t Telephone No.Owner's Address tf{ Co .)SErzcA 'TIo6J ra• YMvviovf1f rogr 7G2-/911>
Is this permit in conjunction with a bulding PP 7TFeist'• Yes No ❑ (Check Appropriate Boz)
Purpose of 3ufl g VP G/,14p Krieg N $40f Ut7ity AuthorizaonNo.Eoisan Service `/ Ams 1 -
/� F f OD / Volts Overhead ❑ Undgrd No.of Meters �_
New Service Amps / Vohs Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity /
Ce - Location and Nature of Proposed Electrical Work.: c.f i
ielI-ID 4T u�, T5 4 err, t_ -rs
Completion of the followap sable mcy be waived by the lrspec/or of Firm
No.of Recessed Luminaires -1..... INo.of Cetl-S4sp•(Paddle)Fans ,.dr No.of Total
Traasforme s �- I{yA
No. ofLuminaire Outlets (o Il - INo.ofHot Tubs _419- Generators • .49 h"VA '
No. of Lnmfaaires 5 o•Pool '`have Lien;
IPo.CI fimergeney Ltgtozng -
erred. 0 erred. 0 BatteryUnits -0-
Na of Receptacle Outlets . 16 No.of Oil Boners IFIR&ALARMS INo.of Zones 2.
No.of Switches 1 Zm
, No.of Gzs B -ners No.of Detection and -
• Initiatbses Devices
No,of Ranges /'{ 5/1 I INo.of Air Cared _Li T a No.ofAlertiag Devices
[G l
No.of Waste Disposers .e- IHeat Pump I Number.I Tons I KW INC.of Setf-Contained
Totals: -�'` Detection/Alertin.oDevices -
No.of Dishwashers '1Space./Area Heating KW' Local Mttaidpal
I � Q Cotrnectien 0 Ofher
>r No.of Dryers 'Heating Appliances ...9^ KW Security Systems:*
J No.of Water No.of Devices or Equivalent�"
�' Heaters KW No.of Ar No,of Data Wiring: -
' Signs Banarte No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors ,...V.Total RP Telecommnniratoas Wiring
Na of Devices or Equivalent
OTHER
Attach oddifiowl detail p'desired or as required by the Inspector of Wives.
C) Estimated Value of Electrical World 3/C00 (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 electical work may issue unless
14 the licensee provides proof ofliability 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 eerty, ander the pains and penalties of poppy,that the information on this application is erne and compfde.
FIRM NAME:
LIC NO.:
Licensee Si LIG
afire —�
NO.:
¶applcable.enter"ctempt"In the license member line.)
Address, Bns,Tel. •No��—
•Per M.G.L.C. 147,S.57-61,securitywork requiresAlt TeL No
OWNER'S INSURANCE WAIVER: Department of Public Safety"S"License: Lie.No. =
- required ' law, 8 I am aware that the Licensee does not have the liability insurance coverage normally
•S my signatnre,17e1n{v_I hereby waive this requirement 1 am the(check one)❑owner ❑owner's agent.
Truer/AgentOoit
((//�p`.t��"
Signature
•
Telephone Nah7A^762-/8/(o I PERMIT FEE' $