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Home My WebLink AboutBlde-20-000119 Commonwealth of Official Use Only r � Massachusetts Permit No. 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:7/9/2019 BLDE-20-000119 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 describe below. ((�� Location(Street&Number) 14&16 COURTLAND WAY ��,� 5 below. , lam/ Owner or Tenant 4otaifflablABARITrE Telephone No. ,,.�j lJ Owner's Address 4 /��j"��i Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec lux) /j" Purpose of Building Utility Authorization No. ' ' Existing Service Amps Volts Overhead 0 Undgrd 0 New Service 100 Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install service(Public)for septic system. 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- 0 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 Initiatine 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:* 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: Jeffrey T Foss Licensee: Jeffrey T Foss Signature LIC.NO.: 36938 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:33 SULLIVAN RD,W YARMOUTH MA 026733543 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 n Commonwealth o`Maddachudet� Official Use Only ) ••-' '..--k ,• ,-'• c� n Permit No. �2 `�t l -_�_ Apartment o��ire Serviced _�{__ " Occupancy and Fee Checked ___ __C/ '.;�.....- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) AP PLICATION FOR PERMIT TO PERFORM ELECTR CAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M 527 MR 12.00 Q '1P EASE PRINT IN INK OR TYPL INFORA TION) Date: W City or Town of: To the Inspector f r3 es: > his application the undersigne)Ø.4V&ryes notice of his or her in ntion to perform the electrical work described below. N /s�/6 c� SWAY �,. � ��.o�ation(Street& Number) (� sr /'IVII�`t�lt LU ' c ,3D4ner or Tenant 6 . //f/{ t e Telephone No. 771/yf 3� t,z (,� --r : I'ler's Address r� I t`iLJr �I LI. —' 1is ttis permit in conjunction with a building permit? Yes n No (Check Appropriate Box) 1ce itprpose of Building Utility uthorization No. sExisting Service20 Amps GI° /a/O Volts Overhead Undgrd n New Service ID6 Amps /ZD /Zit) Volts Overhead N Undgrd n No.of Meters Number of Feeders and Ampacity Location and Natu of Proposed Electrical Work: I,� S? t n 14 1®�/ie /11(4e,E///o Cdc,A:fA4 e e/ - SYs `M Completion of the followin&table may e wa.,ed by the Inspector of Wires. o.oTotal No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf Trranan KVAsformers 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. Initiatingon Detectionand 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 KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: /r No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of cct cgJ„Work: �— (When required by municipal policy.) Work to Start: // Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: 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 soyerage is in force,and has exhibited proof of same to the ermit issuin office. CHECK ONE: INSURANCE BOND ❑ OTHER El (Specify:) ��?P/e2 0t( j a /7 /certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: e ' J �S Signature o, LIC.NO.: E3 71. (If applicabi me "e {np "in the'' ns rnuf'fer li e / Bus.Tel.No.: �j /9 Address: v 4 �✓ I YI// / /y Alt.Tel.No.:--' u' / / �o/� *Per M.G. 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. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.