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Home My WebLink AboutE-20-409 Commonwealth of Official Use Only E. ,� - Massachusetts Permit No. BLDE-20-000409 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:7/24/2019 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) 10 SURFSIDE TERRACE Owner or Tenant GRIMES THOMAS A Telephone No. Owner's Address 12 WINDSOR RD, EAST WALPOLE, MA 02032 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: Repairs to service as needed. 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- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones "-c) 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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: A J PULLEY Licensee: A J Pulley Signature LIC.NO.: 21843 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:289 QUAKER MEETING HOUSE,RD,E SANDWICH MA 025371366 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 yertt#,-- 2,( 6, ,17 Zo I l ( civW.4 to i1 ( / „,N..._, l�OIItIRORft/tatrh of//laarfs Official Use Onl N.., ,� c- _ - --ii�= _ 2eparfma t o/.}ire Serviced Permit No. --� (O 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7-4,1.1 7 , ...)_ : City or Town of: M YAROUTH To the Inspector of Wires: By this application the pridersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) 1 p S,-;,z S b , S• jekv .wLcwr►i Owner or Tenant -7D14„ G121144r=S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No r/- (Check Appropriate Box) Purpose of Building Utility Authorization No. t1jU,,, ,;t,.J i e�'L ) VSryfie Existing Service 7e;(2 Amps 1 2 / _ k ' Volts Overhead C< 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 /� lZa--/l�=tit f'cJnt� i32.J,c� �_S�di �'r-�v9Gl ,/2�� L1 A7T s_ Al s rrAi. &i,'J L r--)\.. . +FL DitC? ,,, 1n�FioLAck- J 1L : i Completion of the follawinvable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Snsp.(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 li mergency Lighting arnd.. rrnd. Battery Units No.of Receptacle Outlets No.of Oft Burners FIRE ALARMS JNo.of Zones • No.of Switches Na,of Gas Burners 'No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tans No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection Other ' No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters ' No.of Data Wiring Signs Ballasts No.of Devices or Equivalent F No. Hydromassa a Bathtubs No.of Motors Total HP g 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 7-6.f-1 q 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 covers is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BO ND � OTHER (Specify:) I cerfn)", under the pains and penalties olP�iu that the informationon this application is true and complete. �', FIRM NAME: j?,=v 1?„,_2t•. F[.ra-r/2.rr.*t i t„,r. LIC.NO.: Licensee: .4._'f. ILL Uwe= Signature --- LIC.NO.: +fit 3 (If applicable,enter"exempt"in a license number line.) Address-:2 q t„`t„„ �V Bus.TeL No.:.Lt..AA- 4,t•U V Alt.Tel.No.: J 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 o required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner 0 owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 5.0