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Home My WebLink AboutBLDE-20-000027 Commonwealth of Official Use Only or �c Massachusetts Permit No. BLDE-20-000027 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:7/1/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice 01 his or her intention to pKo.4 th etec ical wo describedbelAow. Location(Street&Number) 138 ROUTE 6A � We- Owner or Tenant SWIFT DAVID H Telephone No. Owner's Address 138 ROUTE 6A,YARMOUTH PORT, MA 02675-1645 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 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: SITE VISIT 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. 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 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: Nathan A Burkhart Licensee: Nathan A Burkhart Signature LIC.NO.: 14374 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:84 ELM ST, UXBRIDGE MA 015693103 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:$45.00 7/2.1;? CrrMosa[tk _/ c 14440114 Official Use Only ,• :, e c7 Permit No. ' oe Z7 • = s nt o`.tire Servicse . _ _I__ s Occupancy and Fee Checked _,y ,,.;- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 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: 1 f °J 1 i y City or Town of: V6s-"D;,, VI To the Inspector of Wires: c By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 13 I 2, &4 _, Owner or Tenant til ark {• Ke t-.v. 1.,ar2,,,a.A s Telephone No.(6-ao 3(a4-R4'1 --? Owner's Address 68 g" ()t) ,\1 �.v. Q&rv..4-..\,Il,p_ 11 A 02 0 Is this permit in conjunction with a building permit? Yes Ea No[] (Check Appropriate Box) Purpose of Building 1`e.vu,o ' Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: S 1 te, v I .S 1 IL Completion of the followingtable may be waived by the Inspector of Wires. No. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransfKVAormers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above Li In- No.of Emergency Lighting grnd. grnd. Li Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. Detection and Initiating Devices ot No.of Ranges No.of Air Cond. Toons No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste DisposersTotals: - _..._...__......._......._.._..._ Detection/Alerting Devices No.of DishwashersSpace/Area HeatingKW Local Municipal 0 Other Cyonnection No.of Dryers Heating Appliances KWN Security Systems.* or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: d Y g No.of Devices or Equivalent OTHER: GO i Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) 1— Work to Start: 71 g(ti Inspections to be requested in accordance with MEC Rule 10,and upon completion. T� INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless j the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The --4 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. c. CHECK ONE: INSURANCE ® BOND 0 OTHER® (Specify:) --C-) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: ._ .. Licensee: �t,�1Ac.,.vv 1� , 9;,,._.___ ' Signature A . gJNL1i LIC.NO.: Iq 3 4- (If applicable,enter "exempt"in the license number line.) Bus.TeL No.' 7'7`/ IFI�-O$� Address: SsE.1,,. g. 0 itbr',c M A 0 is-6` Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ l , 7' — seAllq ct I I I 44S-t".::%12r-1-.PL-c t.o-n.c(