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Home My WebLink AboutBLDE-18-001576 Commonwealth of Official Use Only or.�, Massachusetts Permit No. BLDE-18-001576 11 �E BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked FRev.l/071 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:9/19/2017 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) 66 LAKE RD Owner or Tenant HAGEN RICHARD S Telephone No. Owner's Address 66 LAKE RD,WEST YARMOUTH, MA 02673 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 eters New Service Amps Volts Overhead 0 Undgrd 0 o. Mr rs Number of Feeders and Ampacity . Location and Nature of Proposed Electrical Work: Install heating system,kitchen outlets,smoke dete • ,44ep a Completion of the following tab!, 4 a , Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.ofO Tot�aall Transformers iJ/`J'`�" No.of Luminaire Outlets No.of Hot Tubs Generators 0 No.of Luminaires Swimming Pool Above 0 In- ❑. No.of Emergency Light grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zo 0 e 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 t� Ton. 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 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 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: MICHAEL S WALSH Licensee: Michael S Walsh Signature LIC.NO.: 29315 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:4 OXFORDSHIRE PL,MASHPEE MA 026493447 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 n • ` l~ Massachusetts t-Cmin0M.Vir th of/r/assac O5cial U e Only 18 y3 cc77 .7 [[�� Permit No. -! I '7( 1'iD `11� .1JePar(,ncnf of..Pira Services ee Checked F en m BOARD OF FIRE PREVENTION REGULATIONS ev. l/0ncyaad „blank) E m ev. 1/07] (leave blank) L7 —o . n APPLICATION. FOR PERMIT TO PERFORM ELECTRICAL WORK O 13 m Dto a All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12.00 x oC(PLEASE PRINT ININKORTYPEALL INFORhl4TI0NJ Date: lot j/Z ii =t m City or Town of: YARMOUTH To the Inspector of Wires: vBy this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 0& Lhk Q `( OwnerorTenant AAA Yd cs'scv-- Telephone No. Owner's Address S A '& Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Burlfitngc„S Utility Authorization No. Existing Service )DO Amps Ito /EKO Volts Overhead 9• Undgrd❑ No.of Meters t. New Service _ Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work lave_ Ser4A. 8fck.-. , lite-1+5 Ka k4.4-‘ aul'14`S S4mekz Jo Oekes . _. . Completion ofthefollowin?tale may be waived by the Inspector of Fines. No.of Recessed Luminaires No.of Cert-Susp.(Paddle)Fans ' (Transformers ICVA No.of Luminaire Outlets No.ofot Tubs Hot IG:aen[ors • (CVA ' No.of Luminaires S• svi.,.+++;,,g Pool Above hi- 1.342 °IEmergency Lighting - Arad. 0 hind. 0Ittervunits No.of Receptacle Outlets . No.of OR Burners (FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners f No.of Detection and - 11 Initiating Devices TNo.of Ranges INo.of Air Cond. Toa No.of Alerting Devices No.of Waste Disposers (Heat PumpTotals: DI Number Tons ICW iNo.of Self-Contained 3 3 etection/Alertino Devices No.of Dishwashers • Space/Area Heating ICW' LocalMunicipal ❑Connection 0 Other o No.of Dryers Heating Appliances KW Security Systems:• of 1 No.of Water , No.of No.of Data°WirDevices or Equivalent - Heaters Signs Ballasts Na of Devices or Equivalent No.Hydromassage Bathtubs INo.of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent tO O1HER: J Estimated VAttach additional detail if desired oras required by the Inspector of(Firer. Value of Electrical Word (When required by municipal policy.) tiA Work to Start g lig/j 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. f INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless • d the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The undersigned certifies that such coove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [✓J BOND 0 OTHER 0 (Specify.) I certify, under the pains and penalties ofperjray,that the information on this application is true and complete. FIRM NAME: MLA S la41.0.1 LIC.NO.: E21315 9. Licensee: M,43 RAst Signature 11 _. ALIC.NO.: gain (If applicable,enter"conga"in the license number line) Address: 4 (7) tb5U``�t {t( a(.H3 ¢t t074'4 q Bus.TeL NoS31--_ot112 J 'Per M.G.L.c. 147,s.57-61,security work requires D' artment of Public Saf ( Alt Teo No.: a4 63 - 15 - OWNER'S INSURANCE WAIVER I am aware that the Licensee does nor have the liability insuLrance coverage n�- required q� d by law. By my signature below,I hereby waive this requirement. Tam the(check one)0 owner El owner's agent Owner/Agent jSignature Telephone No. I PERMIT FEE: $