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Home My WebLink AboutBLDE-19-007144 Commonwealth of Official Use Only `cam, Massachusetts Permit No. B0LDE-19-007144 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] 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:6/19/2019 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. Location(Street&Number) 18 MICHELLES PATH Owner or Tenant MEDVECKY RICHARD D Telephone No. Owner's Address MEDVECKY PATRICIA M, 180 VARNEY RD,CENTER BARNSTEAD, NH 03225 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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement air cond.system. 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 Above ❑ In- ❑ 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 ❑ 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: KUNG-PO TANG Licensee: Kung-Po Tang Signature LIC.NO.: 52286 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:518 COTUIT RD, MASHPEE MA 026492351 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 (azi' P 71 C __- ` - _ commoruuaaCt __, el//la ac�susetfi • Official Use Only a9� . 1eparfmant oi..f'ire Serviced Permit No. CI Z: Occupancy and Fee Checked fi .-f BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) —� c� 'Q • PPLICATION FOR:PERMIT TO PERFORM� � ELECTRICAL WORK t i All work to be performed in accordance with the Massachusetts Electrical Cod (MEC),527 CMR 12.00 kt • EPRINT IN INK OR TYPE ALL INFORMATION) Date: Qj W E i o City or Town of: YARMOUTH To the Inspector of Wires: .J • jl i- application the pndersigned . es notice of is her inp1ti o perform the electrical work des bed below. .,,=tion (Street&Num er) C N j G�tC.ti I.Ls 5 �q /� � C�, Ylrrmo� Owner or Tenant 11" e dV C Telephone No. Owner's Address Is this permit in conj ction a!milling 7rmit?ZQ. 0 g y� ❑ No( ( heck Appropriate Box) Purpose of Building �j S a Utility Authorization No. Existing Service Amps / Volts Overhead ❑. Und d gr ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 11- ( Ye f a Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No,of Ceti-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- [Battery of Emergency Ltghtmg • =rud. grad. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS JNo.of Zones No.of Switches No.of Gas Burners No.of Detection and - a Initiating Devices l No.of Air Cond. T 0 No.of Ranges Tons No.of Alerting Devices . ,, No.of Waste Disposers HS p I Number Tons j No.of Self-Contained Totals: DetectioNAlertingDgvices i , No.of Dishwashers Space/Area Heating KW Local❑ Municipal 4 Connection ❑ Other No.of Dryers Heating Appliances KA, Security Systems:* p> No.of Water No.of No.of Devices or Equivalent ' Heaters ' No.of Data Wiring: v Sites Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER No.of Devices or Equivalent Attach additional detail if desires( or as required by the Inspector of Wires. .._t Estimated Value of/^Elech}c l Work (When required by municipal oli Work to Start: '("1 �( � P �•) Inspections to be requested in accordance with MEC Rule 10,and upon completion INSURANCE COVERA E: Unless waived by the owner,no permit for the performance of electrical work may issue the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent unless \ undersigned certifies that such o erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE n] BOND I certify, under thepains and penalties o ❑ OTHER 0 (Specify:) p fperlury,that the information on this application is true and complete. 1 FIRM NA E: Licensee: — LIC.NO.: Signs re (If applicable t ' pt"1 e lice !e ne.) LIC.NO. -� Address: ,U i Z._lL s �� d �CE Bus.TeL No.: - 166 j Per M.G.L. c. 147,s.57-61,security work requires DepartmAlt.TeL No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabili Lic • ran No. required by law. By my signature below,I hereby waive this requirement. I am the(check one owner se coveragew n �. Owner/Agent ❑owner's a eat Signature l Telephone No. . PERMIT FEE: $ 0 '