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Home My WebLink AboutE-18-5716 / '1lommonweaIth Official Use Only of Permit No. BLDE-18-005716 fi Massachusetts 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:4/11/2018 City or Town of: YARMOUTH To the///Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform th etncal work describ d below. Location(Street&Number) 27 CAPT YORK RD elith SI Owner or Tenant THAYER WALTER D Telephone No. Owner's Address THAYER ELIZABETH L, P O BOX 120, HADLEY, MA 01035 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 N, New Service Amps Volts Overhead 0 Undgrd 0 o.of �� IAiMg Number of Feeders and Ampactty1 IV Location and Nature of Proposed Electrical Work: Basement remodel 40. ' Completion of the following table may be waiv n r• ires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of ray : Transformers K` No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Batter,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/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 Siens 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: 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 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:$200.00 .G)0 G.4( b ., cs � (&(l.6Jc%tOE i,1, e..v�, c 1 L zrc � M- (w ' e _- aeic - gu- 4,(((ti 7 f o rirrprtur^r f� oil/�/a6fccf lcse� Oin 1 list • Permit No.. 1Jcpar..rr-mr-e of J �cry ere Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS )Rev. 1/D71 . (le„ve blank) ---- APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be pe,loaned in accordance wit tbn e lliassanhuseus Electrical Code(_MEC),527 Cla 12.00 (PLEASE PP_1rIrT_INprKOR ,JE.,l.LINFORRDTION) Date: City or Town or: ARMQTEI To theInspector of Wires: By this application the Ilndeiped -ves notice of his or her intention to perform the electrical work described below. • Location (Street&Number) /&,t` Owner or Tenant .,( 44,,pa, Hurt? (9.,,,,�,1 Telephone No. �� t i� _c I Owner's Address SG ,,,.‘-e Is this permit in conjunction wit a brlding permit? Yes n No (Check Appropriate Son) Purpose of Guild."mg j11 olke. fat 6 Uti-lity Authorization No. -...._ u.. FAsting Service Amps / Volts Overhead Undgrd_ No, of Meters New Service Amps / Volt Overhead Undgrd e ''"" • Number of Feeders and Ampacity I I NO. of Meters Location and Nature or Proposed Electrical Work.: a 58 w n-A — - Completion of the jo.aaw-Tz;table may be wived by the IrspeaLor o f Wires �g No. of Recessed cur,fi ,ems No.or Total :r No. of C�1�usp.(Paddle)Fans Transformers KVA No. of Luminaire.Outlet No.not Ent Tubs Generators KVA • Nn, of Luminaires 5 mTrgPont _kb aye In- -n.nr taergencyL'•ghang • mod. ❑ _,d. ❑ Eatery IIztfs No.. of Receptacle Dulcet I C No. of OE Burners 1FME ALARMS No. of Zones No. of Switches No. of Gs Burners iNa.of Detection and No. of Ranges Total � 'Devices No... of Air Cond. Tons 1No.of Alerting Devices No.of Waste Disposers Heat Pump Number I'Tons IKW ((No. of Self-Contained Totem Iv: I I IDetecuon/Aleranz Devices No. of Dishwashers 5 acWArea Heating K-W Murticig2l F LocaI❑ Connection ❑ Oates No.of Dryers Heating Appliances KWSecurity Systems:" No. of Water No.of Devices or Equivalent Heaters KW No. of No.of Data Writing; Signs Ballast No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OT IRR: Attach additional detail if desired, or as required by the Inspector of wires. Estimated Value of Electrical Work: (`)(.2c> (When required by municipal policy.) Work to Start: /, N nspectons to be requested in accorrLLnce with MEC Rule ID,and upon completion. INSURAhO'E 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 E (Specify:) I certify, tender the pains and penalties of p s, tca the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: ----_ Signature LIC.NO.:___________ (If applicable, enter "esem n pt"in the license umber line.) Address Bus.Tel.No.. j Per M.G.L. c. 147, s.57-61,securityAlt TeL No.: work re quires Department of Public Safety"S"License: Lic.No. — OWNER'S INSURANCE WAIVER: I am away that the Licensee does nor have the liability insurance coverage normally 5 required by law. y siratvr low,I hereby waive this requirement I am the(check one)❑ owner ❑owner's agent Owner/amen ep one J. 5i�atzzre' l Telephone N Jovstg- 0.2- I PERMIT FEE: $ 1