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Home My WebLink AboutBlde-20-001406 Commonwealth of Official Use Only E0Massachusetts Permit No. BLDE-20-001406 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•9/12/2019 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) 184 SOUTH SEA AVE UNIT 4 Owner or Tenant BLANCHARD WILLIAM L TRS Telephone No. Owner's Address BLANCHARD NORENE E, 16138 BOLLARD DR, CROSBY,TX 77532 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: Septic pump&alarm. 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- ❑ 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 No.of Detection and Initiative 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 1 Totals: Detection/Alertine 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 Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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: BRIAN A SMITH Licensee: Brian A Smith Signature LIC.NO.: 24307 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:20 GELDING CIR, BARNSTABLE MA 026301503 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 s ''// C�omnaonwsaith of/�I��jj assac Official UseOnly ,, fi • \`T �+ = c� cc77 nn Permit No. EVO_ =. _!f1_11-=- 5 Zepartnr nt o/..74.&rvic.. , BOARD OF FIRE PREVENTION REGULATIONS Occupancy �0 ry) (l Fee blank) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code I C),52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 // „70/7 City or Town of: YAR1VIOUTH To the I •ecto of Wires: By this application the undersigned gives notice of his or her intention�on to perform the electrical work described below. Location (Street&Number) /f"/ j0Z�leF r 1&, 12A/// Owner or Tenant ! /)le', , /je/Z~ Telephone No. Owner's Address /f/3 b ^ kj, 0/%a ilea, ep/ - q 77,�� Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building ,i4; Utility Authorization No. Existing Service ir_76 Amps AZ0/?fin Volts Overhead Undgrd❑ No.of Meters / New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A-)//a/9 A/60(0. Jr i/C c"t``v Completion of the followingtable may be waived by the Inspector of Wirer. No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fags 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, rrnd. Batter,Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating 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/Alerting Devices i No.of Dishwashers Space/Area Heating KW Local D Monnectionunicipal 0 other C No.of Dryers Heating Appliances ICW Security Systems:* No.of WaterH No.of No. No.of Devices or Equivalent eaters ' 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: Inspections to be requested in accordance with MEC Rule l 0,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless ‘\1 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The Qi undersigned certifies that such c_ove�a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E BOND ❑ OTHER ❑ (Specify:) ! I certify, under the paitts and penalties alperjury,that the information on is applic - is true and complete. FIRM NAME: ,�� A / LIC.NO.- 7 Licensee: 41714/f Signature �' !?IC.NO.: \` (If applicable.enter"exe t 'in the lice e numbe li / `li Address: 0 cj Bus.Tel.No.:C� j.O� 57�l j J *Per M.G.L. c. 147,s.57-61,securitywork requiresAlt.Tel.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 n�ly S required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. m Owner/Agent I Signature Telephone No. I PERMIT FEE: $