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Home My WebLink AboutBLDE-18-000091 Commonwealth of Official Use Only x4 `S Massachusetts Permit No. BLDE-18-000091 -- BOARD BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/07j 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 electrical work described below. .�r/ / Location(Street&Number) 2 HIGH GROVE RD .P Lll'(p Owner or Tenant GROPMAN RICHARD Telephone No. Owner's Address GROPMAN MAUREEN C,2 HIGH GROVE ROAD,SOUTH YARMOUTH,MA 02664 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 ❑ Undgrd 0 r rs ' New Service Amps Volts Overhead ❑ Undgrd ^ 1'i•.i Mr. Number of Feeders and Proposed 1 {�y� /n,// Location and Nature of Proposed Electrical Work: Install ductless NCAI /. ( iv Completion of the following table may y 's}• ctor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.ofTransformers ` A y No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- I: No.of Emergency Lighting grnd. grnd. Battery Units - _ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons 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 , 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: DANIEL J PECKHAM Licensee: Daniel J Peckham Signature LIC.NO.: 26830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LW, 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 Telephone No. PERMIT FEE:$50.00 PM R(' 3(, 7 rcE apar \ ammonai al masse eer • .The Only =7ne=- &r.=nt o{. +.Jcrnrrtd .✓'Pea it No. _\-Y\ BOARD OF F1RE PREVENTION REGULATIONSO`er®`�and Fee Che`ked . lro>) (leave blank) APPLICATION FO.R=PERMET TO PERFORM ELECTRICAL WORK All work to be per armed in accorthsce with the Massachosco5 Electrical Code ICJ, '27 CM3t 12DU 0 —.ryl (P LF�4SEPRIR'TLVD OR TYPE ALL NFORbt4TIONJ Date: W jrfG1 YARMOUTH City or Toru or. o To the I •e or of Wires: tbi By this application the undersigned gives notice of his or her intention to perform de electrical work described below. tit, p ,-‘.31Location(Street&Number) h .✓rla fjanu< sT- Kei l __I OwnerorTrantyna,iA1�e Atop ?Keanli Telephone No. . i. Owner's Address ---•---___---•---___t t1.---___l_- i. Is this permit it conjunction with a buildingpermit? Yes ❑ No -----.-- Purpose of Buflnrng .❑ (Check Appropr st°Boz) Utility Authorization No. Erica;Service nips / Volts Overhead ❑ Dutra❑ No.of Meters New Seryke __ Amps / Volts Overhead❑ Undgrd 0 NO.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Meedzical Wot'6. ` Ike vi__,, cet.,,T Lfr_s_4L Completion of the followba table mcy be waved by the lrspealor ofWire& No.of Recessed Lnrri...:rmINa of Cet7.-ell (Paddle)Fars INo. of Total Transformers ICVA No.of Luminaire Order INa of Hot Tabs IG-...aerators • RVA. ' • Na. of Luminaires IS *T.,- nv Pool Abvd.w_ 0I111-d. 0 iENn.of i',murger/kagntmv erreerr ett rvIIribs Na. of Receptacle OctNo.of OE Burners ' I IFSiiS ALARMS 'No.of Zones No. of Switches INo.of Gas a roers No.of De.cuoa and IN Inifrat Devices No.of Rams I '1 oral No.of Air Cored. Tons Miro,ofA[ertiagDevices • No.of Waste Disposers IHeatPump Number Tons KW [No.of Setf-Contsine Totals: De on/?leste Devices No.of Dishwashers • 'Space/Area Heating KW' Local D.Ml Conecfiumapaon ID Oder No.of Dryers (Heating Appliances Ky, Security Systems:` No.of Water No.of Devices or&trivalent Heaters KWNo. of No. of Data Wiring: Sias Ballasts No.of Devices or nivalent 1 No.Hydromassage Bathtubs No. of Motors Total ply Telecotamnnicztions Wiring OTHER No.of Devices or Equivalent — • Est mated Value of Electrical W ort_ 1r°ch additional detail if desired,or as required by the Inspector of Weer. Work to Start (When required by municipal 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 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 ahrbited proof of same to the permit issuing office. CHECK ONE: NSURANCF BOND 0 OTHER 0 (Specify:) cn4 � pains and pe altr: of p a 'mg,that the information on this app5icetion is true and complete FIRMN Licensee `e s LIC NO.: ''� I. �. LIC.NO: Aaf ddressable,enter"Qe„p �e license giber tine) Signature p�x� I // �/— Bos.Tel.No__ J `Per M.CLL.e. 147,s.5:7-6 security work D b '� Alt TeL No.3yA» � OWNER'S INSURAN re-quires eparunent of Public Safety"S"License:. Lin No. required by law, CE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally Owaerd by la By toy signature below,I hereby waive this rnquircment I em the(check one)0 owner 0 owner's agent t Stenatre Telephone No. I PERMIT FEE: S