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Home My WebLink AboutE-19-5180 Commonwealth of �.le Official Use Only Massachusetts Permit No. BLDE-19-005180 `It1,9 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•3/14/2019 City or Town of: YARMOUTH To the Inspector of Wires: ^� �y By this application the undersigned gives notice of his or her intention to perto t electrical work c /ed below. O /✓5--� et, 8j 7 ,, Location(Street&Number) 40 BELVEDERE TERR l K`� i&IO(Qk I 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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Septic pump m&alarm, recessed lights, receptacles, &bathroom fan. 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 grid. grid. Battery Units111 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:* ('n No.of Devices or Equivalent �Y 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 ❑ (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: D rN"6204ifte 11 till(q 6V-LAINV‘io ear46, I 2- 190n010/1(274- cr-zai,c pow O el 11 Gels Z +3 sj.o(t 9 7zR 4 q,( , ..c.? ------ — Commonwealth of Mamacku..ietti Official Use Only • = me-` .dJeparfineri ol.}irs Jarviced Permit No. `-�C—``S Q BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 1/07] (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NIEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: i r City or Town of: YARMOUTH To the Inspector of Wires: .•- — �:?By!this application the Emdersigned gives notice of his or her intention to perform the electrical work described below. - i-L tion(Street&Number) 1 Q t . f /.1e/ VCdtre Terrace. er or Tenant ,(� Q > cri. / �^ '- A,Kt-- /k�yc,�.,,L Telephone No. 1 U.l .-1 b�vner's Address / Aet -tV.0(ci L Teri is c t (�1(,) ,, '_*is permit in conjunction with a building 1 �t �' ;,iut�ose of Building �n,`fht-d( g permit _ Yes � No ❑ (Check Appropriate Box) ui __. .____i_. r, ,g al -/Ytf-r-F Utility Authorization No. - q__.a___ 16znag Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Und d gr ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Q(i--&/- d fly L 1 L A aw„j ,. _ ,,!7_ I Completion of the following table may be waived by thednspector of Wires. No.of Recessed Luminaires 7_ff No.of Cei1.-Susp.(Paddle)Fans No.of Total Transformers I{VA No. of Luminaire Outlets ,•m-.,•.t - No.of Hot Tubs '.2 Generators I VA r� No.of Luminaires Swimmin Pool Above In- -No.of Emergency Lighting - g grnd. grnd. Battery Units No.of Receptacle Outlets X +),, ; ,' No.of Oil Burners #'-�f _ FIRE ALARMS [No.of Zones No.of Switches 0 No.of Gas Burners 'No.of Detection and Initiating Devices No.of Ranges {PI No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers !" Heat Pump I Number I Tons I KW No.of Self-Contained •I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal c Cpnnection ❑ Omer No.of Dryers Heating Appliances , Security S stems:* No.of Water No.of Devices or Equivalent of No.of Heaters KW No. Signs Ballasts Data Wiring: No.of Devices or Equivalent --k..: No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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: tPa p ) 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 s. 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 enalties ofperjury,that the information on this application is true FIRM NAME: PP and complete. Licensee: LIC.NO.: Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: . Address Bus.Tel.No.: — J `Per M.G.L. c. 147,s.57-61,security work requires Department of Public SafetyAlt Tel No.: OWNER'S INSURANCE WAIVER: 1 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 0 owner ❑owner's a ent. Owner/Agent Signature 1.11 Telephone No. PERMIT FEE: $ 7�=