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Home My WebLink AboutBlde-20-001901 r to Official Use Only �Eor tlu Commonwealth of .�►, Massachusetts Permit No. BLDE-20-001901 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:10/7/2019 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 described below. Location(Street&Number) 14 PILGRIM RD Owner or Tenant MALVEY ANN MARIE Telephone No. Owner's Address 28 WORCESTER ST, GRAFTON, MA 01519 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: Relocate thermostat&CAN jack. 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 Initiatinc 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/Alertinc 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 Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 2 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: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 21302 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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 c - ,),12,_.• 1%fr 1 iitzeD i o/pi 7- , ci,..c)jti ✓ -sT ) !v G c , ,w t4 Official Use Only _>E{ `/ �- Permit No. ` � (0 r� 2ap nt al s ® z -ts , Occupancy and Fee Checked (g,l an = - BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] . ame blank) o I < APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK Li. ' c) All work to be performed in accordance with the Massachusetts Electrical Code MEC), Zoo U rL„, z (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / b 7 /2' LV rL) o o City or Town of: YARMOUTH To the Inspect r of Tres: j g. 1 By this application the undersigned eives notice o pr her intention tof the electrical work described below. C°5 Location(Street&Number) / V / (,(-Li �rn,a L') - �'' n, 4�, t Owner or Tenant ANAJ l kR Ili_t .} j,)k,�7 /{i f i as Telephone No. &-£93-Cs-� Owner's Address a Gt.Jt;i2 e-tz q 9--e r- Cr ref c4 ,- 441- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps I 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: btie I LI_ -t- I N5- f) C19 y t 3-tleL A A v k 54-a'T . Completion of the following table may be waived by the brsoaclor of Wires. No.of-- . No.of Recessed Luminaires No.of Cel.-Susp.(Paddle)Fans Transformers KVA _ 0- No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ 'Pio.oil mergency)Tgnung -- grad. crud. Battery Units No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS No.of Zones ' n and No.of Switches No.of Gas Burners No.of - e Devices .. --.1 No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices - t t_i Heat PumpNumber Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detetdion/Alertinu Devices No.of Dishwashers Space/Area Heating KW' Local❑Munnicneipaln 0 Oilier , ' Coctio ,a( No.of Dryers Heating Appliances KW Security Systems:* ,�1. No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: 3 Heaters Signs Ballasts No.of Devices or Equivalent , No.Hydromassage Bathtubs No.of Motors Total HP Teleco of Devicesations Equivalent No.of or Equivalent ...y(, O I kihR: Attach additional detail if desitt:d or as required by the Inspector of Wires. Estimated Value of Electrical Wo± (When required by municipal policy.) Work to Start 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 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, a. CHECK ONE: INSURANCE. BOND 0 OTHER 0 (Specify:) e---1 I cerirfy,under the pains and penalties ofperjury,that the i, trinatian onkthis application is true and complete. CY FIRM NAME: Ct I f }�; Wia. l I--1-e itC_1 rj TAX LIC.NO.:/3o ,,. Licensee: (A� 4Zt' 1IQi( S"fgnature R Q,'bl f,,Q2& LIC NO. 3 (If applicable,enter"erempt"in the licer2e number line) Bus.Tel No.: , Address: vt()A)m t rF ( /0 - WAD C'� 1A rM L U 1't Alt.Tel.No.:,r?DU"��'( -441 7 M: J *Per G. c. 14 ,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 ❑owner's agent. Owner/Agent cl Signature Telephone No. I PERMIT FEE: $ .6 `c, I