HomeMy WebLinkAboutBlde-20-000005 a< �(� l'` Commonwealth of Official Use Only
-E� � Massachusetts
Permit No. BLDE-20-000005
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:7/1/2019
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. 44
Location(Street&Number) 21 ERICKSON WAY S 4-1 Lit.l
Owner or Tenant MCEiEl Telephone No.
Owner's Address M.CifiC--Alkii4F.A.21 ERICKSON WAY, SOUTH YARMOUTH, MA 02664
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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring for new sunroom.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans 1 No.of Total
Transformers KVA
No.of Luminaire Outlets 2 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 6 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 5 No.of Gas Burners No.of Detection and
Initiatine 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 ❑ 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: 1
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: Richard A Haarman
Licensee: Richard A Haarman Signature LIC.NO.: 13615
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 18 Holmes Rd, Harwich MA 026452219 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
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(_ Occupancy and Fee Checked /c ov
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: 6/28/2019
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 Erickson Way
Owner or Tenant Chris Freeman Telephone No.
Owner's Address Same
Is this permit in conjunction with a building permit? Yes ® No n (Check Appropriate Box)
Purpose of Building Dwelling Utility Authorization No.
Existing Service 100 Amps 120/ 240 Volts Overhead® Undgrd❑ No.of Meters 1
New Service Amps / Volts Overhead❑ Undgrd ElNo.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wire new sunroom
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans No.of Total
1 Transformers KVA
No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA
`.\ Above In- No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units
No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones
-l'' No.of Switches s No.of Gas Burners No.of Detection and
Initiating Devices
,.,._._..�...,._ ,... Total
No.of Ranges No.of Air Cond. 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❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KWNo.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications NofDeieor Equivalent
1
No.of Devices 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:6/28/2019 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 ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Haarman Electric, Inc LIC.NO.: 13615 A
. C)Licensee: Richard A Haarman Signature LIC.NO.:33511 E
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No. 508-789-5410
Address: 18 Holmes Rd Harwich,MA 02645 Rick@haarmanelectric.com Alt.Tel.No.:
*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 normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: ,SSignature Telephone No.