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Home My WebLink AboutBlde-20-000150 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000150 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:7/11/2019 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) 19 BLISCOTT AVE Owner or Tenant TULLY BARBARA M Telephone No. Owner's Address 28 MELROSE ST,WORCESTER, MA 01605-1821 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&alarm. 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 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 1 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 1 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: Michael F Simonis Licensee: Michael F Simonis Signature LIC.NO.: 16862 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 1488, EAST DENNIS MA 026411488 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 Signatures Telephone No. PERMIT FEE: $50.00 7(«/(1 7/( (9 ,/ Commonwealth of Maniac „Of Official Use Only y ( J ca c�= -1Je T-•tire Serviced Permit No. �( p ► o t . f= = Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] • (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA) Date: /y 64. City or Town of: YAR1VIOUTH To the Inspector o Wires_ l - . By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ----..• Location (Street&Number) / 9 Li SGv I /J -r_____ Owner or Tenant Telephone No. -7. Owner's Address �/9--r.-- -t Is this permit in conjunction with a buil is '► g/P�t. es ❑ No ��(Check Appropriate Box) Purpose of Buildia //)q� /� /h ` Utility Authorization No. Existing Service Amps_ / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .��` �/ / / �i�liy�' �� r-- r/�`�/."�S'f/ /ov�{J9 �` �G-1i�c/'`ip /� Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Cei1-Susp.(Paddle)Fans No.of Total Transformers RyA No.of Luminaire Outlets No.of Hot Tubs Generators I(VA No.of Luminaires Swimmia Pool Above In- No.of Lmergency Lighting g Prnd. ❑ arnd. ❑ Battery Units /l No.of Receptacle Outlets Na.of Oil Burners FIRE ALARMS INo.of Zones • No.of Switches No,of Gas Burners No.of Detection and 9l Initiating Devices No.of Ranges Total j Na of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: I f Detection/Alerting Devices IA No.of Dishwashers Space/Area Heating KW' Loth❑ Municipal 1-1 Other _ Connection No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices or Equivalent No.of 1 Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent ,A No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: V No.of Devices or Equivalent OTHER; r Attach additional detail if desires( or as required by the Inspector ofWires. Estimated Value of Electrical Work (When required by municipal policy.) Work to Start /o / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VERAG : 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 covers is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BO ND ❑ OTHER ❑ (Specify:) / 2�-,--e�r— s 0 I cerfy, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAMEss2,r,e nis ,,G LIC.NO.: /G �� _� G Licensee: ` ----- r..--9®rJrS Signature� �� ZIC.NO.:�a sgr (If applicab a enter"erempr"in the license number line) Address: �. Bus.TeL No.: � - s1'1?9_$ 7 f3D 1( �'7iQ� l,Jr7� �y1Ff. £) 3 6 ? Alt Tel.No.: J� *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 normally required by law. By my signature below,I hereby waive this requirement I am the(check one)❑owner 0 owner's agent. Owner/Agent I Signature Telephone No. [PERMIT FEE: $ su—(�—