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Home My WebLink AboutBLDE-20-000243 Commonwealth of Official Use Only e or n Permit No. BLDE-20-000243 � 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:7/16/2019 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 belo Location(Street&Number) 15 BLUEBERRY PATH VILLAGI "Dl al�L AO Owner or Tenant S Telephone No. Owner's Address 15 BLUEBERRY PATH,YARMOUTH PORT, MA 02675-1475 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: Wire new rooms to code. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 14 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 4 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 15 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 8 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: Michael D Guertin Licensee: Michael D Guertin Signature LIC.NO.: 51373 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 HEATHCLIFF RD, SOUTH DENNIS MA 02660 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: $75.00 J C. 7117 il Gt Gig- t (5((`? ' ( -) 9(110 &it, $ l&- • —_ _ Commonwealth off///asiachsusctti .. Offic ial Use Only = an =- 2)eparfn:ent el.yin Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ` '` [Rev. 1/07) (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA) Date: '% 16/1 q City or Town of: YARMOUTH To the I ector of Wires: By this application the r,mdeisigned gives notice of his or her intention to perform the electrical work des bed below. Location (Street&Number) (5 8(,V.e eer per"( l/Np �ypore K ,s e�1J, \� Owner or Tenant !/hA Ai1 lL . 3 �1 Telephone No. Owner's Address `j.f ri Se- Is this permit in conjunction with a building permit? Yes E No . ❑ (Check Appropriate Box) Purpose of Building F,i1/!,$1( (q.$-erei6/J7. Utility Authorization No. Existing Service Amps / Volts Overhead E. 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: A._,E <. tea!HS --7—r Ga OIL' Completion of the followinvable may be waived by the Inspector of Fires. No.of Recessed Luminaires /y No.of Cei--Susp.(Paddle)Fans No.of Total 9 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- No.of Emergency Lighting - _rnd. erred. 0 Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS _INo.of Zones • No.of Switches g No.of Gas Burners No.of Detection and - Initiatine Devices Total No.of Ranges No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Aierting Devices No.of Dishwashers Space/Area Heating KW Local D Municipal Connection ❑ Other No.of Dryers Heating Appliances , 'Security Systems:* No.of Water No.of No.of Devices or Equivalent No.of Heaters KW Signs Ballasts Data Wiring: 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 desired or as required by the Inspector of Wires. Estimated Value of electrical Work C 060 0.---' Work to Start t 5` (When required by municipal policy.) I L 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. 'M 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. N' CHECK ONE: INSURANCE a BOND 0 OTHER 0 (S ci � I cetYify, under the pains and � �') penalties ofperlury,that the information on this application is true and complete. v FIRM NAME: )11(On 4C1,... n (1-4...p2e7//0C-"L 7 ,C!/-I/v LIC.NO.: ,�-� 'Ni Licensee: ,7/C7,t�5L )j &--U-e //i� Signature —'L"``�� (Ifapplicab! nter"erempt"in the license number line.) � E LIC.NO.: N. Address: I T�S(GGtFtC,e 7 So►rrk DE�J/L!S ,v//q Oa G G Q Bus.Tel.No. 'Vab'7 ,J Per M.G.L. c. 147,s.57-61,securitywork requiresAlt.T .No.: 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 S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner ❑owner's a ent Owner/Agent I Signature Telephone No. PERMIT FEE: $