E-19-6548 Commonwealth of Official Use Only
"L , Massachusetts Permit No. BLDE-19-006548
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:5/20/2019
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) 15&17 THACHER ST
Owner or Tenant BRAZEAU ROBERT W Telephone No.
Owner's Address BRAZEAU JOAN, 15 THACHER ST,YARMOUTH PORT, MA 02675-1123
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 ❑ 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: Replacement boiler.
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 1 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/Alertinu 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 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: Kung-Po Tang
Licensee: Kung-Po Tang Signature LIC.NO.: 52286
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:518 COTUIT RD, MASHPEE MA 026492351 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
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t=: epartrnent Permit No.��l Q"-(nS`l"
5ire Serviced
> ' <. 1_L =• ' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
w .''�7 ,[Rev. 1/07] (leave blank)W o
V Q . I • PPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WO
W E m 1 All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 WORK
-SE PRINT IN INK OR TYPE ALL INFORMATION) Date:
YARMOUTH '�� 7 G
Cityor To of: To the Inspector of Wires:
By this application the undersigned gives notice of his or her intentio to perfo a electrical w describ4, below.
•
Location (Street&N ber) ill aGj g '- s f - \ e v av
Owner or Tenant 1r0` Ova_
Telephone No.2.12�Z�cf
Owner's Address
Is this permit in conjunction=building erm it? Yes No (Check Appropriate Box)
Purpoa of BuiIding -5 i - GG (
Utility Authorization No.
Existing Service Amps / Volts Overhead ❑, Undgrd
❑ No.of Meters
New Service Amps / Volts Overhead E Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: f:70) g// KI(1.//-
Completion of the followirztable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No. of CeiL-Susp.(Paddle)Fans No.of Total Transformers
Transformers KV�,
No. of Luminaire Outlets No.of Hot Tubs Generators KVA
`b
V No. of Luminaires Swimming Poo, Above ❑ In- ❑ No.of l".mergency Lighting -
arnd.. arnd Battery Units
�. Receptacle Outlets No. of
No.of Oil Burners FIRE ALARMS f No.of Zones
No.of SwitchesNo.of Detection and
�. No.of Gas Burners
- Initiating Devices
Total .
No.of Ranges INo. of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number l I Tons )KW No,of Self-Contained
Totals: I _Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW LocalMunicipal
Q.) Q Connection OtherNo.of Dryers Heating Appliances , Security Systems:*
No.of Water No. of No.of Devices or Equivalent
Q) Heaters KW No.of Data Wiring; r
v 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 Ely- cal rk (When required by municipal policy.)
Work to Start:c Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: nless 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: LIC.NO.:
I Licensee:
0 ( Signature LIC.NO.:�Z Z
I (If applicable " em in;he ens m e e.) ia. xeyf 4�/,f Bus.Tel.No.:-? 7 -7)
Address GCJ ( Alt.Tel.No.:
1 "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 nrmally
5 required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner ❑owner's agent
0 Owner/Agent
Signature
01 - Telephone No. PERMIT FEE: $