The URL can be used to link to this page

Home My WebLink AboutBlde-19-006073 �, (� Commonwealth of Official Use Only Ifi Massachusetts Permit No. BLDE-19-006073 / BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR , 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•4/26/2019 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) 3 OAK GLEN VILLAGE Owner or Tenant YOUNG DAVID Telephone No. Owner's Address YOUNG SANDRA, 18 WESTVIEW DR, MANSFIELD, MA 02048 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: Wiring for basement. 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 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 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:) Q�6 g S— 1194 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. v FIRM NAME: MATTHEW D KLINE Licensee: MATTHEW D KLINE Signature LIC.NO.: 53620 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 Nehoiden St, Harwich Port MA undefined 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: $75.00 PjVrij / ( '3 ? ( 6/, Vletie? alb `dc(te Commonwealth of///assacLwalts Official Use Only 1-=� cc�'�� c�-�]� // _-=gft= .1Jtparfinenf of tint Services Permit No. q ((�/ _ti f Occupancy and Fee Checked ---_7 :�+ram BOARD OF FIRE PREVENTION REGULATIONS [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: 'V/7.,(//q City or Town of: YARMOUTH To the Inspector of Wires: By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. _.... -- Location (Street&Number) 3 v ri 11 C�•e+) ( KI h '.� Wc. j f\ z Owner or Tenant 4��, Y ✓r --J Telephone No, f 7 ?� ?�� ' = Owner's Address I Is this permit in conjunction with a budding permit? Yes No a�,i � _, purpose of Building �MI !� ❑ (Check Appropriate Box) Utility Authorization No. E )l�zistiag Service Amps / Volts Overhead ❑ Uad d '" a l;'t ❑ No,of Meters ►, V - New Service Amps / Volts Overhead❑ Und d_. 1'T ❑ No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: • 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 l.mergency Lighting ernd . rand. ❑ Battery Units No. of Receptacle Outlets No.of OR Burners FIRE ALARMS 1No.of Zones No.of Switches No.of Gas Burners 'No.of Detection and J Initiating Devices Total No.of Ranges No. of Air Cond. Tons No.of Alerting Devices 1 • No.of Waste Disposers Heat Pamp I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Municipal Local i ❑ onnection ❑ Other 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: >7...eit:3re (When required by municipal policy.) Work to Start: )J2•3- 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 ® 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: LIC.NO.: Licensee: /14N t K ii.t..� Signature ' LIC.NO.: 33GZ.6.-- (If applicable. enter"cresol"" the license mber line.) Address: ' ''; �� k J 411-Vi 4 Bus.Tel.No.: 08 3 %13"� J Per M.G.L. c. 147,s.57-61,security workrequires Alt.Tel.No.: Department of Public Safety"S"License: Lic.No. ‘zr— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n o ly 5 required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent I Signature Telephone No. I PERMIT FEE: $ I