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Home My WebLink AboutBLDE-19-004390 ... Commonwealth of Official Use Only --y Massachusetts Permit No. BLDE-19 004390 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:1/30/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform t ell ical) rkwork described el w. Location(Street&Number) 19 BENNETT AVEC �:_.fI v Owner or Tenant ODONNELL MARILYN A Telephone No. Owner's Address 85 SAINT AGATHA RD, MILTON, MA 02186-4336 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- o 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 Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers 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 No.of Devices or Equivalent HeatersWater KW No.of No.of Data Wiring: 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: DANIEL J PECKHAM Licensee: Daniel J Peckham Signature LIC.NO.: 26830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LN, MARSTONS MLS MA 026481629 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 k\--7,4 (3(c9 tib o - • - .1. • -•- lronunonwsa J yy� Y =_=-_.t ///assachuzeifs •• • Official Use I \ _ .-.-1-=�'=: c`� ` - gi i atparfntanf of.7irs Services Permit No. til Q O V =t_ -"'- BOARD OF FIRE PREVENTION REGULATIONS Ov an and Fee Checked eave blank �— APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK AU work to be performed in accordance with the Massachusetts EIecttical Code t C),527 CMR I2 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH `��' By this application the trndersi ed To the I •eCtor of Wires: gra gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) • rii..-e-h Owner or Tenantk f Telephone No. „ ��, ;;Owner's Address 1 'IIs this permit in conjunction with a buildingpermit?P rtnit• Yes ❑ No ❑ (Check Appropriate Boz) purpose of Building Utility Authorization No. 1xistiteg Service Am I ' . Amps . Volts Overhead ❑ Undgrd❑ No.of Meters .- ew Service Amps / Volts Overhead ` � ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ` n l(f1►L � f�C�mr i ��i Com letion o the ollowin table m be waived the Ins ector o Wires. No.of Recessed Luminaires No.of CeiL-S (Paddle)Fans o.of Transformers Total No. of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No. of Luminaires Swimming Pool No. Above In- `o.o mergency ,an ❑ ted- ❑ Bette • Units g �rnd. No.of Receptacle Outlets -- of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and No.of Ranges Initiating Devices No. of Air Cond. ° Tons No.of Alerting Devices posers Heat Pump umber Tons o.of elf-Contain- No.of Waste Die Totals: Detection/Mertin• Devices No.of Dishwashers Space/Area Heating KW' Local❑ Municipal _ Connection ❑ Other \ No,of ater No.of Dryers Heating Appliances , Secttrity Systems:* 1No.of Devices or E.uivalent No.o o.of Data Wiring: S Heaters KW Si• s Ballasts (, No.Hydromassage Bathtubs Na.of Devices or E nivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or .uivalent tt Estimated Value of Electrical Work Attach additional detail if desired or as required bythe Inspector ofW' P ties. Work to Start: (When required by municipal policy.) INSURANCE----COVERAGE: Unlesswaivedby the owons to be ner,no permit ted in accordance the with MEC e el and upon completion. the licensee provides proof of liability insurance includingperformanceof electrical work mayissue undersigned certifies that such coverage is in force,and has'exhibit d proofrof same to the permit on"coverage or its substantial ssue nan o 1 office. alent, unless 11 CHECK ONE: INSURANCEg ffice. I certify, under the pains and penalties 0 OTHER ❑ (Specify:) P (perjury,that the information on this application is true and FIRM NAME: comp.: Licensee: LIC.NO.: I Signature / ----�_ 1 (If applicable.enter `.t•'in the license number line.) „,,7„ ' LIC.NO.: Address �, C/ Bus.Tel.No.: j "Per Address: M.G.L. c. 147,s.57-6 ,securityu ILS r0`c Cs �Z' , Alt.Tel.No. OWNER'S [NSU work requires Department of Public Safety"S"License: Lic.No. S See 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 o Owner/Agent ,I Signature ❑owner's a ezt. Telephone No. PERMIT FEE: $