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Home My WebLink AboutBLDE-18-002403 K Commonwealth of Official Use Only /At ,. Massachusetts Permit No. BLDE-18-002403 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:10/23/2017 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. Location(Street&Number) 29 PAINE RD Owner or Tenant PAGLIARULO GEORGE J Telephone No. Owner's Address PAGLIARULO MICHELE,3 R OLD COACH RD, HUDSON, NH 03051 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 ❑ Undgrd ❑ 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: Wring for addition(Porch) Completion of the following lab i y be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. i Total Tr 6.. en KVA No.of Luminaire Outlets 6 No.of Hot Tubs fet ,ti KVA No.of Luminaires Swimming Pool Above 0 In- ❑ 6104/7 BatNo.o r grnd. grnd. Battery O y} No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALA IS/lyrr /� No.of Switches 4 No.of Gas Burners No.of Detection A! J 1V/� Initiatina Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons O // No.of Waste Disposers Ileal Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: etyR 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 Siens Ballasts No.of Devices or Equivalent I No.Ilydromassage Bathtubs No.of Motors Total HI' Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail iifdesired,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 co*,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Henry J Jordan Licensee: Henry J Jordan Signature LIC.NO.: 24434 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:50 BLUE ROCK RD, S YARMOUTH MA 026641333 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 1`— W2- I Y71 r? re' ` �-. l�ommontuea(r/a e7t �` OOff cigUse V'lt � apa-Lneni o{giro...ECM" Permit No.C( CS/- 1_3 , BOARD FIRE PREVENTION REGULATIONS Ooc y®ry and Fee Checked �� OF Rev. 1/07] . 0 e blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All wort m be performed in accordance with the Massachuscas Electrical Code(MEC),527 CMR 12D0 (PLEASE PRINT EV.ThIK OR 77PE ALL INFORM4TION) Date: City or Town of: y.A.RmouTH To the Inspectoropfines: By this application the imdersiped gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) e ' r Owner•orTenant GP,ppal e_ Pa/ n /apuJ , Telephone No.42 7 Owner's Address 5',..nt Is this permit in conjunction with a btulding permit? Yes C No ❑ (CheckA ro ) Purpose of Btuldag 4C Lys 2 6 02Gt f PPPt��Boz)Utility Authorization No, Ells-ling Service ��"' Amps _evtt_ 120 l no Volts Overhead Undgrd❑ No.of Meters l New Service Amps / Volts Overhead fl ❑ IIad�d ❑ NO. of Meters Number of Fevers aced 4mpscitp -f z Location and Nature of Proposed Electrical Work. i , Al4 r ^r :O N :ys a 1I.1 C�1 —11 Completion of the follow ng able mry be waived the Ir No.of Recessed L¢ byImpactor ofWiirer. Vt!x'- ��s INo.of Cet1.-S'usp.(Paddle)Fans INoa of CVA V9 Trzasformss O No. of Lumista re Ovtletr La INo.rofHot Tubs !Generators la'VA ' f,,r 1 lm 4 No. of Luminaires /' ISam,...,++Q Pool Above ❑ Ice- ❑ rio.of n,mergeury Lagn>mg t0 nd. °rnd- p%at<erptaitr i No.of Receptacle Outlets _2. INn.of Oil Burners IFTRE MAIMS INo.of Zones No.of Switches No.of Gzs Burners No.of Detection aced No, of Ranges Total IniCatine Devices INo.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers (Heat Pump I Number ITons IKW `Na of Self-Contained Totals: IDetection/41e..rtins Devices No. of Dishwashers ISpaeeJArea Heating KW' L ❑Mtmidpal Connection 0 Other No.of Dryers Hea' tang Appliances KW Security Systems: No.of Water No. of No.of No.of Devices or Equivalent Heaters KW Ballasts bats Wuing Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Telecotnmuniratiorts Wiring No.of Deciees or Equivalent At / cch addition&detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Wort. ✓ (When required by m apolicy.) uaicip1 P c)•) Work to Start .*54P_____Inspections to be=Nested 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 ctertiJY,ander the pains and penalties of perjury, that the information on this app&acaiion is true and complete FIRM NAME: LIC.NO.: Licensee:.1&114_3,rTn2n 4✓ -- Signature � LIC.NO: (If applicable.enter "mpt••in the license rtum.er line) J Aeq ddress. teel JCl :.I d Bus.TeLNo :- _ eftez j TL Per M.G.L. c, 147, s.57_61, security work ruires D •.artment of Public Safety"S"License: Alt Lic.No. ____________ OWNER'S INSURANCE WAIVER: required b law. I am aware that the Licensee does not have the liability insurance coverage normally eq it Y signature eIow,I hereby waive this requirement 1 am the(check one 0 ownero t Owner/Age y __ 0 owners n�cn^ oiSignature •t Telephone No‘6.•7�� S� PERMIT FEE: S 7