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Home My WebLink AboutBLDE-18-000094 Commonwealth of Official Use Only kw" Massachusetts Permit No. BLDE-18-000094 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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: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 perform the electrical work described below. Location(Street&Number) 40 LAVENDER LN Owner or Tenant ANDRADE KATHERINE A Telephone No. Owner's Address 40 LAVENDER LN,WEST YARMOUTH,MA 02673 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building - Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd Et. No.of Meters New Service Amps Volts Overhead ❑ Undgr �t'�//�Vo.of Meters Number of Feeders and Am pacify C/`VytV� Location and Nature of Proposed Electrical Work: Replacement boiler and new ductles Completion of the fo A • .• ' , t,.r/ e Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transform KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency/10 74 �V p grnd. Arnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones CJ No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Ileat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other. Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent OTHER: Attach additional detail ifdesire4 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 ❑ BOND 0 OTHER ❑ (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 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) ❑ ossner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 4 1/4. _ Cimuronweelh of 21444,4-4-195 s �.. : OroeialUm Oa�J' PerzittNo. .--47. = 7cprrneraf o �i+Y Jnoixi BOARD OF RRE PREVENTION REGULATIONSOoe¢peacy and Fee Checked -Rev. I/o73. (!cave bleat) -- APPLICATION FO.RIPERMET TO PERFORM ELECTRICAL WORK S .--. 1 .All work to be par formEmoteed Emote wit the Mzssechase¢s Electrical Code . "27 CMR 1200 lid (PLEASE PRINT Mr/71 OR TYPE ALLINFORM470NJ Date: 7 ..,.! o .1 p i City or Town on YARMOUTH To the Inspector of Wires: �" I 0-,•...." By this application the l ersiped gives notice of his or her intention to perform the electrical work described below. • w o II Location (S-reet&Number) 90 Lat/t.e.A. L ri • o = 1 Owner orTenant fermi y &Nit e..1-! Telephone No. in —' Owner's Address 13 1^; I Is thisermitin conjunction with a building e F permit? Yes ❑ No ❑ (Check Appropriat Boz) Purpose of Building Utility.4nthorintion Na. Externa;Service Amps / Volts OverEead ❑ IInd,.rd❑ No.of Metei s New Service Amps / Volts Overhead ❑ Qndgrd❑ NO. of Meters Number of Feeders and Ampadty Locati n and Nature of Proposed Dentinal Work: it cf., ii ___ _._. Completion of the followber table may be weived by the Inspector ofF irm No.of Recessed Lrsm:,..;,--s No.of Cetl$4ssp.(Paddle)Fans (N0.of Total. Trznsformers ls.'VA No. of Luminaire Cratlets No.of Hot Tabs IGeneratots • KVA ' Na. of Ltimiaaires Swimm ng Pool Above Ia aunt of ame-gency Li nting - tnt crud. ❑ 1B,..-...r?Dints No. of Receptacle O¢ttets . No.of OE Em tees 1PME ALAR yg IN¢.of Zones No. of Switches No.of Gzs Burners {No.of paentioa end 1 Devices No.of Rages No.of Air Cant Total II.iro.of Aiertiag Devices • Tons No.of Waste Disposers Heat Pump I Number Tons KW (No.of Setf-Uont:atned Totals: IDetectionlMlertine Dews No.of Dishwashers Space/Area Heating KW I Mani ' a ILo�Q Caan�oln 0 Other - No.of Dryers Heatiag Appliances ICW (Security Systems:r No.of Water No.of Devices or Equivalent No. of No. of Data Wit ng Heaters KW Signs Ballasts No.of Devices or E trivalent No.Hydromassage Bzthtnbs No.of Motors Total HP Telecommnaitations [rine Na of Devices or Equivalent O 1 tit,R: • • Attach additional detail r'derirei( oras required by the Inspector of FPtres. Estimated Value of Electrical Work (Wh Work to Starr (When rognired by municipal policy.) Work 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 inchitiing"completed operation"coverage 05 its substantial ecipivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: NSURANCI! BOND 0 OTHER 0 (S f certify, ander the paint a n'� px ) penalty's ofPerjrup,that the inforrxairax on rfrs application it tree and complete FIRM NAME; LIC NO.: ____________ Licensee:110 N ee_t r- ��L ,)wSignat¢ra LIG NO.aarclaal icoble.enter". .. .t"fn the license number fine). Address: ;>♦i /.., -/ Bas.TeL No.: j `Per M.G.L.c. 347.s.57-. eJ " a Alt Tel.No I,security work requires Department of Public Safety"S"License: Lie.No. — OWNER'S INSURANCE WAIVER I am aware that the Licensee does nor have the liability insurance coverage normally t reguircl law. By my signature below,I hereby waive this requirement I emnett the(check one)0 owner 0 owner's ',1 Signature_ TeIephane No. :: I PERMIT FEE: S