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Home My WebLink AboutBlde-19-005952 or 1,4I Commonwealth of Official Use Only tri ' A Massachusetts Permit No. BLDE-19-005952 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:4/22/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform ttte electrical work descpbed b low. Location(Street&Number) 105 WIANNO RD --"JT' Ee- (",/1 Owner or Tenant F/`"'^c ^'1"'cJ`A•- Telephone Yo. Owner's Address 105 WIANNO RD,YARMOUTH PORT, MA 02675 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: Remodel basement&bathroom. Completion of the following table may be waived by the Inspector or Tres. 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 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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 Siens 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: TYLER W PAYNE Licensee: Tyler W Payne Signature LIC.NO.: 22091 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:5 JANS PATH, HARWICH MA 026452458 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: $75.00 -1%k_eive t (l4 7ez 2( s (Lei es-- 4)4(_ ?/ v'e T Commonwealth of Massachusetts Official UseOnly • Permit No. t J Z- f ,. „_ Department of Fire Services ,7S`^ / e �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked tpV [Rev.9/O51 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527C',MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: £I/ZZ� [[ i "1 City or Town of: 9 QX m U v`(\ 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) 105 (oQ n n o lcad Owner or Tenant 1 e y. Reef)ee CCUM l) Telephone No.11 y4 7.03N2... ,. _ - 'Owner's Address I 0 ( t(�l n no cac w_ _ wLu 1us this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) �' t P > urpose of Building Utility Authorization No. "`.,"'d ;< Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters 2 '' Number of Feeders and Ampacity r` ` Location and Nature of Proposed Electrical Work: -Bose C U (kind balhfricjen ,-* :- foc,9 h _ ---___, Completion of the followin&table may be waived by the Inspector of Wires. NoNo.of Recessed Luminaires No.of Ceil.-Susp. Trano KVATota(Paddle)Fans f Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool 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 Detectionand Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Self-Contained No.of Waste Disposers HeaTotp t Pum Number Tons KW Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Monnectunicipalion ❑ other No.of Dryers Heating Appliances KW Security No.of f Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsNfDevices or Equivalent y g No.of Devices 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/ IQ ii q 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. CHECK ONE: INSURANCE,] BOND ❑ OTHER 0 (Specify:) I certify,under the pains and pentilties of perjury,that the information on this application is true and complete. FIRM NAME: P i NE EL, C" Ct C pi(. LIC.NO.;5307 Licensee:"1-./Lot IN. i7ikYl' a Signature/ Z�41,./A) C...--.. LIC.NO.:2z(If applicabl enter"exempt"in the license number line.) � Bus.Tel.No.. T-l:7 .3,. i Tel.No.: Tri ;Lt Z Address:� .��'� i�fF�j"f-f- '�lel/1(K� Alt. 3eci2, *Security System Contractor License required for this work;if applicable,enter the license number here: 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 PERMIT FEE:$ Signature Telephone No.