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Home My WebLink AboutBLDE-20-001149 o* Commonwealth of Official Use Only • Massachusetts Permit No. BLDE-20-001149 � 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:8/30/2019 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) 11 ARROWHEAD DR Owner or Tenant THOMPSON JOHN D Telephone No. Owner's Address THOMPSON EMILDA A, 11 ARROWHEAD DR,YARMOUTH PORT, MA 02675 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: Replacement boiler. 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 1 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 ❑ 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 Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: DAVID R NICOLL Licensee: David R Nicoll Signature LIC.NO.: 37557 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 144 DRIFTWOOD LN, S YARMOUTH MA 026641038 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 "'— [ c1 ozrirnrtit f . itV,- _�.I' e.t• 4 1 41 (P._= 1== ,1' Occupant' and Fee Ceeci:e �� r -'r BOARD OF FIRE PREVENTION REGULATIONS `L_ tile,. tJ?1 16,Lip-10.—,..2,0.-Dpi ILI7 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AB wor}.to be performed in accordance with the stassacnaseas Eiecuical Code(\1ECl.52 7 CAIR 12.{1i1 (PLEASE PRINT IN INK OR TYP LL INFORMATION) Date: O c)t, a t ( City or Town of: AgAtz or* To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to per{orm the electrical work described below. Location(Street&Number) /l #4-7MO Q�74�,[�./� PE/\ Owner or Tenant 444' ,v1` _�`' Telephone No.— _— Owner's Address 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 No.of Meters New Service Amps / Volts Overhead Undgrd L2 No. of Meters Number of Feeders and Ampacity MI ', F N f tt,ull i" �� '� t it y,et) Location and Nature of Proposed Electrical Work: eL : ,SyS76411 Completion of the followint;table may he waived by the Inspector of Wires. 1No. of Recessed Luminaires INo. of Ceil.-Susp. (Paddle)Fans No•of Tonal ! I- 1Transformers KVA iNo. of Luminaire Outlets INo. of Hot Tubs (Generators KVA jNo. of Luminaires Swin�ntina Pool Ab e J in- ' `No.of Emergency Lighting I g grnc {Battery Units No. of Receptacle Outlets 1No. of Oil Burners !FIRE ALARMS No. of Zones 1 2 ;No.of Detection and No. of Switches :No. of Gas Burners Initiating Devices Total No. of Ranges 1No. of Air Cond. Tons No.of Alerting Devices \o. of Waste Disposers Heat Pump Number I Tons 1 KW INo.of Self-Contained 1 Totals:, (Detection/Alerting Devices ' No. of Dishwashers !Space/Area Heating.KW ;Local r Municipalo cho ' Other Connection , , - 'No.of Dryers Heating Appliances KW i Security o.of Devices or Equivalent 'No. of Water 'No. of� No. of `:Data Wiring: Heaters KW i Signs Ballasts No.of Devices or Eauivalettt • , No. Hydromassage Bathtubs INo. of Motors Total HP Telecommunications Wiring: No.of Devices or Eouivalent OTHER: Attach additional detail if desired, or as required in•the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE " BOND L.2 OTHER _ ( eci y:' I certify, under the/tains and penahnes of pet ttrs, that the ittfarntatior ti this npiicati i i true and ' teat rt. FIRJ'I NAME: r x r LIC. NO.. ram-7 r Licensee: Signature I LIC. NO.: (If t ` ,t°>y ! (�`' °2•1 applicable,` elver "exempt"in the license rutntber line./ Bus. Tel. No.: - Address: `i e};: i , ?,tom• i ,s k 4-t t) (7'I Alt.Tel.No.. t . -Per M.G.L. c. 147. s 57-611,security work requires Depannient of Public Safer} "S" License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally required bt law. B, my signature below.I hereby waive this requirement. I am the (check one; owner owner's agent. Own°e.r!Acen_ S:�nauu'e ?eieni�one\;,. PERI-lIT FEU=. s