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Home My WebLink AboutBlde-19-000380 ,. 1(.1P Commonwealth of Official Use Only Eli% Massachusetts Permit No. BIDE-19-000380 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:7/18/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives no ice o us or er men ion o per on a ectrica work descri low. Location(Street&Number) 11 POWHATAN RD k.AS 1 LL 3 ,,,2.., Owner or Tenant GOLLIFF KAREN H Telephone No. Owner's Address 11 POWHATAN RD,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 's,A.i.._. . opriate Box) Purpose of Building Utility Authoriza o, i. Existing Service Amps Volts Overhead 0 Undg-' ' �j A i ' t s New Service Amps Volts Overhead CIUndgr i i.y u ' Number of Feeders and Ampacity /� Location and Nature of Proposed Electrical Work: Changing bedroom to bathroom. A8Q.,Completion of the following table m e Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of O 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 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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 ofperjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 nornially 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 R , 7/ o((81 t..4_, i jv-t ei kg— .00 Commoncvsan o////aesachCudeits Official Use Only _ltil Apartment o f ire Serviced Permit No. Q — -=!- = ' Occupancy and Fee Checked ___71.6 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07j (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: 3-LA)- ('7t -2-c;/b City or Town of: YARMOUTH To the Inspector of Wires: By this application the Indersigned gives notice of his or intention to perform the electrical work described below. Location(Street&Number) q �o J Aq Infcx�MO /✓y � M� O Z 9S Owner or Tenant h e, �S-t/( '&424, J"Telep hone No. Owner's Address b`' _ Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Box) Purpose of Building 79, jj ,,„ AA, b,"4,, ,-... Utility Authorization No. .t. '1 Existing Service X/ ‘mps / Volts Overhead 0 Undgrd l; d❑ 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: ' L ‘eibtezpii 4". Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceit.-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 grad. grnd. Battery Units No.of Receptacle Outlets 3. No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches Z No.of Gas Burners No.of Detection and J Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number-[Tons___I KW No.of Self-Contained Totals: 'r Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal Local❑Connectioother No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters KWNo.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: V (When required by municipal policy.) Work to Start:7/7/f 6 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 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature (If applicable, enter "exempt"in the license number line.) LIC.NO.: Addresr. Bus.Tel.No.: J *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lict No.• -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By sign a below, I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. 7 Owner/Agee I Signature Telephone No.747/- YS 7- l PERMIT FEE: $ 1(77.