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Home My WebLink AboutBLDE-19-000784 • Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-000784 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:8/9/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives nonce of his or her intention to pertorm the electrical work described below. Location(Street&Number) 23 PINE GROVE RD Owner or Tenant BOYLE FREDERIC G Telephone No. Owner's Address BOYLE LESLIE E,23 PINE GROVE RD,SOUTH YARMOUTH,MA 02664 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 ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel basement bath room.Replace receptacles. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires . No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abave ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Unit 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. 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 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 ❑ OTHER 0 (Specify:) I certt.&under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MATTHEW D KLINE Licensee: MATTHEW D KLINE Signature LIC.NO.: 53620 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 Nehoiden St,Harwich Port MA undefined Mt.Tel.No.: "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"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 ❑ owner's agent. Owner/Agent Signature �[ Telephone No. PERMIT FEE:$75.00 4 ° t eh 6� QIv6 s(4'(8 Cg-2) - '(q1(4 .*/ lc,. Use Only-7�ammonma a�/ W4ac tt! PermitNo. 0 i1rjo1s . t-_- 2eparlment ofbre Services sF BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 175" ev. 1/07) (leave blank) 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: • City or Town of: YARMOUTH To the Inspector of Wires: • . By this application the{ndersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) 2," Pi'in-e ((re Ser tjI"t_l` L Owner or Tenant Fr'-l 1t ,/4 Telephone No. Owner's Address mk. Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) G ' Purpose of Building till, c.i Utility Authorization No. cio T Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters New Servicegr 0 No.of Meters Amps Volts Overhead 0 Undgrd ._* +[t�, Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cc. law- Mir"MEW Gar ZhJ 1°or - k'' �ht •tet Lt r��• o • pletion ojthejollowingtabre may be waived by the Inspector of Wirer. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ in-gmd. ❑ ;Lon. Uni.of l mergencyts Lighting grnd No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and • • Initiating Devices No.of Ranges No.of Air Cond. Ton No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained - Totals: Detection/Alerting Devices No.of Dishwashers • S ace/Area HeatingKW' Municipal PLoral❑Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:' - t No.of Water No.of No.of No.of Devices or Equivalent S Heaters Data Wiring: Signs Ballasts No,of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP 'Telecommunications Wiring: Na,of Devices or Equivalent o OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. O Estimated Value of El cal Work: ?o (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless 0othe 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. N CHECK ONE: INSURANCE 2 BOND 0 OTHER 0 (Specify:) I cern)",under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: /4e jt applicable,enter"er fete a number line), .Yo 8 71511 t/Ar v&i dBus.Tel.No.� o /y)as 5 Alt Tel.No.: j J 'Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"5"License: Lic.No. .7-z OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n — required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent d Signature Telephone No. •.• I PERMIT FEE: $