The URL can be used to link to this page

Home My WebLink AboutBlde-20-000571 or Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000571 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:7/31/2019 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) 34 STUDLEY RD Owner or Tenant OLEYER GEORGE R Telephone No. Owner's Address OLEYER SUSAN WALL,467 QUAKER FARMS RD, OXFORD, CT 06478 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 ❑ 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: Repairs to service due to storm. 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 rnd. 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 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: 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. IPERMIT FEE: $50.00 • To C eeeice 0-6 feu l�s HAs . P k2cAC 't ji' (ro►n+nortasatrh of MaddachWaftd Official Use Only �,_ 2epa�„E f rs Serviced Permit No. 'S Q S :' BOARD OF FIRE REGULATIONS Occupancy and Fee Checked _ :'.,` PREVENTION REGUL ev. 1/07] (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),52 CAR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFOR IATIOI9 Date: 1 3 it tiq City or Town of: YARMOUTH To the Inspector o Wires: By this application the undersigned gives notice f his or her intention to perform the electrical work described below. Location (Street&Numl ) 3 ( S- Q Ley f Kvad Owner orb0 Telephone No. /' Owner's Address ` q4L,,,IL2,fie e Is this permit in conjunction with a building permit? Yes ❑ No _ (Check Appropriate Box) Purpose of Building teStCQ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: rM i rc , fu.,---n e( 94-or 0_ 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 lr:mergency Lighting - arnd. and. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1No.of Zones - No.of Switches No.of Gas Burners No.of Detection and • Initiative Devices No.of Ranges No. 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: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Municipal Local D Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Ballasts - Data Wiring; Signs 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 ( �J — Work to Start: (When required by municipal policy.) 6 ot,j 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 V • the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivale undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. nt The CHECK ONE: INSURANCE 0 BOND 0 OTHER ❑ (Specify:) I certifi', under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature _____________ (If applicable,enter"erempt"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 Safety Alt TeL No.: — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLin.No. Q required by law. r signatur below,I hereby waive this requirement. I am the(check one ❑owne�cov❑e Owne�, Owner/A �/ t11 Signature Telephone No.`JO•. -65 1 /6 PERMIT FEE: $50