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Home My WebLink AboutE-20-339 •1�' Commonwealth of Official Use Only Aor Massachusetts Permit No. BLDE-20-000339 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:7/22/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described Belo . Location(Street&Number) 40 BELVEDERE TERR Y"`te-j &.L fec J(,'S Owner or Tenant DEFEURIA JOHN J Telephone No. Owner's Address DEFEURIA ELAINE J L,40 BELVEDERE TER,YARMOUTH PORT, MA 02675-1301 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: Install light&switch for closet. 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 1 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 1 No.of Gas Burners No.of Detection and Initiatinu 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/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ 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 perjuiy,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: $75.00 1 z<<q �€ tnae_ / il/ ?t . ........(\T\ ,.\ Commonwealth of//lassac ffd • cial Use Only i■=_= _8 �J� z�j --=��_= e /�. C7 Permit No. �-- 6— O/✓7 ci .° ..i.,.. " __r f_.._" .-U parfnunf o j crQ J crvicss _— [R - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' •`• ev. 1/07) (leave blank) ADD! InArI".1 r-",r,- ,r:. __ ".11;; I I O -crtrORvi CLCV-i KRGAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.D0 r— (PLEASE PRINT IN INK OR TYPE ALL INFOR MATION) Date: City or Town of: YARMOUTH To the Inspector of Wires: s . f3y this application the undersigned gives notice of his or her intention to perform the electrical work described below. -- Location (Street&Number) `f c� /�e V�d�C 7 t1 - OwnerorTenant /l0.� / X-t /44 a/'q,AA.-) Telephone No. 7`f( 6,077 Owner's Address ,rQ,w,c_ Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Box) ._..`....Purpose of Building AAA +.s r C(ok F Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd gr ❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd g 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f4dtd LE b raj , Completion of the following,table may be waived by the Inspector of-Wires. No.of Recessed Luminaires No.of CeiL-Sasp.(Paddle)Fans No.of Total Traasformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting • arnd. grnd. Battery 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 Number KW No.of Self-Contained Totals:I I Tons I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ '� No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW No.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 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 i surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER. ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: t LIC.NO.: Licensee: (,_ A ---�_ Signature /1/ti.V`y�� LIC.NO.: (If applicable,enter "exempt"in the license number line.) Addresr. Bus.Tel.No.: J Per M.G.L. c. 147, s.57-61,security workrequires Alt.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 normally S required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent. 7 Owner/Agent I Signature Telephone No. I PERMIT FEE: ,$ 7 j - l