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Home My WebLink AboutBLDE-19-006320 4\ e f Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-006320 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:5/8/2019 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 below. Location(Street&Number) 21 CARVER RD Owner or Tenant WAITE STEPHEN G Telephone No. Owner's Address WAITE THERESA, 9 BROUSHANE CIR, SHREWSBURY, MA 01545 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: A/V wiring only. 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 g bovend0 IInnd ❑ No.of Emergency Lighting r 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 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.of Water No.of Devices or Equivalent 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 o perjury,that the information on this applications true and complete. FIRM NAME: Licensee: Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: Address: Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage non-nally 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. I 'PERMIT FEE: $45.00 t 9 74- 6(7.4-(01 C5--- c q3i1 -- /+ --• Commonwealth o / �. K alsactzuietts Official Use Only ', cc�� cc77 Permit No. �—1p 3 240 r 2e artment oi.5ire�erviced t-i _ ,' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK %.. i All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Co lam{ City or Town of: �,rz.Mov T.-1 By this application the undersigned gives otice of his or her intention to performtheTo the Iele t electrical wopector rk Wires: described Location(Street&Number) escnbed below. 2i C-��- v Owner or Tenant 5-reL Owner's Address Telephone No.5)6 3 33 140E5 4c ARINfC Is this permit in conjunction with a building permit? Yes 1,) No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd 0 No.of Meters New ServiceAmps / Volts Overhead fl Number of Feeders and Ampacity Undgrd No.of Meters Location and Nature of Proposed Electrical Work: A t--xuv to /, r ,Z Completion Fof thanse following table maybe waived by the Inspector of Wires. No,of Recessed Luminaires No.of Cell:Susp No.of Tot ) Transformers u No.of Luminaire Outlets w 'A No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above lin- No.o�Emergency Lighting rnd. �rnd. Battery Units c ;No.of Receptacle Outlets No.of Oil Burners 'oFIRE ALARMS iNo.of Zones i . No.of Switches No.of Gas Burners -Noy of Detection and No.of Ranges 1'utal Initiating Devices No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Ileat Pump Number Tons KW No.of Self-Contained Totals: --- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal No.of Dryers Connection E Other rY Heating Appliances KW ecurity ystems: o.o ater KW 0.o 0 o No.of Devices or E uivalent Heaters Si�ns Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Motors ° ' i evices or E•.uivgl nt a Total Hl� ecommunicattons T iring: OTHER: No.of Devices or E•uivalent Aa .(ppU Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of ectical Work: Work to Start: 3 \ p (When required by municipal policy.) Ins ections 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 54 BOND 0 OTHER I certify,under the pains and penalties o 0 (Specify:) FIRM NAME: fperjury,that the information on this application is true and complete. kJ 1 UC<zE-1— . rJ Licensee: LIC.NO.: - (Ifapplicable,enter "exempt"in the license nu ,ear 1, ine•) Signature LIC.NO.: x /v\S' —' . 1--u..L. Bus.Tel.No.:_ "" It Address: \R tSC2T . t G yS it f Alt.Tel.No. *Per M.G.L.c. 147,s.57-61,security work requires De arttnent of Public Safe "S"License: Lic.No. : OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havthe liability insurance coverage normall required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner Owner/Agent Y Signature0 owner's a_ent. Telephone No. PERMIT FEE: $