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Home My WebLink AboutBLDE-18-000092 IV Commonwealth of Offr092cialUseOnly Massachusetts Permit No. BLDE-18-000 ® BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:7/7/2017 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 lectrical work de riltd below. �I f� /�/`JJ'7Qrye3 Location(Street&Number) 12 DAYTON RD tCyi x Cl N "(�/l Owner or Tenant E_NANE:.'WARD Telephone No. Owner's Address _ _ COUT RD,GANSEVOORT,NY 12831-2403 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: Wring for replacement furnace&water heater. Completion of the following table yfag6p aived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transf 431)4}CVA KVA No.of Luminaire Outlets No.of Hot Tubs Gene No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emerge //��grnd. grnd. Battery Units �(�� No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No p l Ills /^^\ /VJ/ s No.of Switches No.of Gas Burners 1 No. at Detection and �O Ini.of e Devicsa No.of Ranges No.of Air Cond. .Too�al No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons - KW No.of Self-Contained Totals: Detection/Alertine Devices % No.of Dishwashers Space/Area Heating KW Local 0 h1unicipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:' No.of Devices or Equivalent No.of Water 1 KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Ilydromassage 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: Daniel J Peckham Licensee: Daniel J Peckham Signature LIC.NO.: 26830 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LN, MARSTONS MLS MA 026481629 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' rTelephone No. PERMIT FEE:$50.00 N/, g/747 . RA ?4<3((7 z �p Coma onuicrl7s of///esaae�.uacftt Oxncial Use Only \� '= . 'Pet�tNo. N� ��' ''�/ Occupancy and Fee Checked BOARD OF RRE PREVENTION REGULATIONS (Rev, 1/07] Nave blank) -------- APPLICATION FO.R:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aeeord?nce with the Massachnse¢t Electrical Code(MEC),527 Cla 12.00 PLEASE 2'IN Th7CORTYPE ALL INFORIATIONJ Date: City or Town of: YARMOUTH To the •e or of Paves: till pie . By this application the vnderniped gives notice of his or her intention to perform the electrical work described below. 1 cam.+ L Location (Street&Number) 1; SG yzon At —\ o A OwnerorTenant k t-e 0 _ Owner's Address l n Telephone No,ILI - I d '-' Is this permit in conjunction with a building �� permit? Yes ❑ No ❑ (Check Appropr st°Bo=) i r% . Purpose of Btn1¢mg } Utility Authorization Nn, ' Existing Service amps / Volts Overhead ❑. IIndgrd❑ No.of Metes s New Service Amps / Volts Overhead❑ Undgrd ❑ Nd.of Meters Nnbber of Peedets and Ampadty Location and Nature of Proposed Electrical Work Completion of the followm?[able mcy be waived by the Irspeetor ofwbac No.of Recessed Laminefr-s No.of Cat-Stsp.(PPdrIle)Fats IN'Traaso,ati Total iormers KVA No. of Luminaire Omiet Na of Eot Tabs 'Generators m VA ' . No.. of Ler,.+: es Swi+nrn:ngPool m-nd ❑ ar-Z o IEAbove La- Onz al rv'Da Sc- Ugzzza' - Na. of Receptacle Orrdt No.of OE Earners lE'lh'R ALARMS 'No.of Zones No. of Switches No.of Gas Earns IND.of Dtecnon and s Devices No.of Ranges Total IND.of.A1ettt Devices Na.of bit Coad. Tons • No.of Wast Disposers HeatT Pomp)Number Tons I KW Oa.of Setif-Conr,i+wd I Detetion/Alertine Devices No.of Dishwashers Space/Am Heating KW' Low Q Municipal - Connection O No.of Dryers Heating Appliances KW Se Systems:" No.of Water No.of D v r.�or Ecuiva teat Heaters KW No. of No.of Data Wiring Signs Ballasts Na of Devices or Egnivalrat t No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring; No of Devices or Equi-valent OTHER: - • Estimated ValueAnal'addition')derail tf tired or m required by the Inspector of Wire, of Electrical Wort (When required by municipal Work to Start � policy.) 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 tmless • the licensee provides proof of liability insurance including"completed operation" coverage or it substantial equivaket The tmdersigoed certifies that such coverage is in forte,and has exhibited proof of same to the permit issuing office CHECK ONE: INSUR.ANc BOND 0 OTHER 0 (Spa *) r ten*, under the paint p • of pa jury,that the brforntoiion on this appfic¢iion is true and complete FIRM NAME: LIC NO.: Licensee ��i�„ / �_ (If applicable, enter cens Signature ,�Q�� LIC NO ••r"m rhe licerue member line) ✓✓ Bus.Tel.No Address: "t r a. / .. J `Per M.O.L. c. 197, s- -61,secwi work s S-„dp Ait Tel No�[�,9— ,_y am OWNER'S INSURAN requires Department ce s Public s nohatyve the License: Lin.No. Q required bylaw. ByCE WAIVER• i am aware that the Licensee does nor have liability insurance coverage n coverage quirt my signature below,I herebywaive this s Owner/Agent requirement Tem the(check one)❑own¢ ❑owner's agent Signature Telephone No. I PERMIT FEE':S