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HomeMy WebLinkAboutBlde-19-007001 Commonwealth of Official Use Only Kt= 7:4Massachusetts Permit No. BLDE-19-007001 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:6/11/2019 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) 24 FROTHINGHAM WAY Owner or Tenant FIEDLER WILLIAM L TRS Telephone No. Owner's Address FIEDLER SHARON L TRS, 8445 MALLARDS WAY, NAPLES, FL 34114 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: replaced septic tank pump and float switches(774-408-0095) 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. grad. Battery 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 ❑ 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: 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: James Farrell Signature LIC.NO.: %55998 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: 7744080095 Address: 140 Round Cove Road, Harwich MA 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: $50.00 3 ettli(� i C-YvVti Lece List , \ 14 Commonw.a[th el Maeeackwie a Official Use Only c-� �/c7 Permit No. & )t -/9" 07W ?+ ! ''' Aparinsani 7`tire Servksd -rl t{ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. i/07] (leave blank) F6U IC 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 P ALL INFOR ON) Date: �Q ' �-/ J � 1 City or Town of: a"f7)c714.Y 1 To the Inspector of Wires: V By this application the undersigned gives notice of his or her intention to performJ the electrical Iwork described below.) Location(Street&Number) l.4 rr0 I �1rt ere Gl1 GZ�/ 4.17yt.74, , r✓� ' iL h t� Owner or Tenant g`l ?( Or) /C`Cd/c r / Telephone No.23-761-�yl ,� Owner's Address tR Li ra ;Jo J-G✓►i A) rc 6o 4.41't )let c cuk_a 1a.Yit ,- Is this permit in conjunction with a building permit? Yes 0 No ® (Check Appropriate Box) .� Purpose of Building Utility Authorization No. (g Existing Service O© Amps 612 I v&VOVolts Overhead❑ Undgrd[ No.of Meters / New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Pro El�; l Work: e )1 t C ri --� . pamp ,-) 1 +1.4- -5141: c..5 Completion of the following table my be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CefL-Susp.(Paddle)Fans No.of Total Transformers KVA Cl No.of Luminaire Outlets No.of Hot Tubs Generators KVA n Above In- ❑ o.ofEmeien Lighting No.of Luminaires SwimmingPoo grnd. ❑ grnd. Battery Units • zi No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ' No.of Switches No.of Gas Burners No.Initiatingon onDete and Devices l 1..1 No.of Ranges No.of Air Cond. Total " ons No.of Alerting Devices Tons No.of Waste D rs Heat Pump Number„Tons KW _ -No.of Self-Contained Noce Totals: �_ Deteetion/Alertiu Devices e)t_ANo.of Dishwashers Spsce/Area Heating KW Local❑ Monneunicip ction 0 Other Cy No.of Dryers Heating Appliances KW Nostems:* .of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent , Telecommunications Wiring. " No.I ydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent — c"., OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: OO (When required by municipal policy.) `� ' Work to Start: -/0 -/ck Ins ctions to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 Ei BOND ❑ OTHER 0 (Specify:) I cerilfy,under the and penalties o ury,t the information on this app ation is5eandcomPlete. FIRM NAME: r5re LIC.NO.:s taq -6 Licensee: Q F Signature LIC.NO.: (If applicabl enter' ene thy�k�ensa�n line.) n,/� C Bus.Tel.No.•"�'• 4-1 -0C (� Address: ANC) UI LLJIJ�. 0 /�1't dJ Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires 5epartment 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 y my signature below,I hereby waive this requirement. I am the(check one)Elowner Elowner's agent Signature f� Telephone No. PERMIT FEE:$ 5 v