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Home My WebLink AboutBlde-18-007051 Commonwealth of Official Use Only ��_ Massachusetts Permit No. BLDE-1 8-007051 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:6/12/2018 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) 23 LEWIS BAY BLVD Owner or Tenant GALLAGHER BRIAN E Telephone No. Owner's Address GALLAGHER JENNIFER A,2 OLD HARRY RD,SOUTHBOROUGH, MA 01772 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check App to Box) Purpose of Building Utility Authorization No. \ Existing Service Amps Volts Overhead 0 Undgrd 0 o.of _ New Service Amps Volts Overhead 0 Undgrd 0 "`��. ; iV � Number of Feeders and Ampacity �� f" Location and Nature of Proposed Electrical Work: Install generator O 8, � O Completion of the following table may be wai ,, c of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of !1 Transformers i'I No.of Luminaire Outlets No.of Hot Tubs Generators 1 . 22 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 Totals: Detection/Alerting 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 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: Joshua M Steacy Licensee: Joshua M Steacy Signature LIC.NO.: 11751 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:23 LIVOLI RD, FRAMINGHAM MA 017013828 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. I PERMIT FEE:$75.00 ----4-z6Ncbt4o&vou-cr- o( oe, .."--- er:j Old ?fri(igr-e- t VA 6.(c e( (- c 0 %i � i eb, Cry -, \ _ Commonursa[th of///adsash .tt • Official Use Only 1 _..i% A) ,,..._ _ __ , r�_,===_=, 2eparfinent l.t Serviced Permit No. l�l 11S 1 u. =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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: rp (/),- Rotg 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(ct work described below. Location(Street&Number) �3 4�k�L 5{A.5A, 17 v�J��c_�ig ( - Owner or Tenant 1 Cc ,,4�^< � �> Telephone No. M /`�` P Owner's Address Is this permit in con,. ction with a�permit? Yes � ❑ No� (Check Appropriate Box) ., Purpose of Building / Utility Authorization No. _-_, _..Existing Service 1160Amps AZO/°? olts Overhead ❑_ Undgrd 7 No.of Meters New, ervice Amps / Volts Overhead❑ Undgrd .D.,,,„, R h U No.of Meters - ' Numi� 1 er of Feeders and Ampacity * . Location and Nature of Proposed Electrical Work: e),Tl"t0,1IS 1-Y•p Completion of the following table may be waived by the Inspector o Wres. No.taCf Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total 1, --, Transformers KVA q, No.of Luminaire Outlets No.of Hot Tubs Generators �1CVA�� . - No.of Luminaires Swimmug Pool Above ❑ In- 0 "No.of Emergency Lighting grnd. _gnu'. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump[Number.. Tons. I KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ri Connection Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters KWNo.of Data Wiring: 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 Elec 1 Work Work to Start: � a 1� (When required by municipal policy.) 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 c, e••._e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE MrBOND ❑ OTHER ❑ (Specify:) I certify, under e ' and,enalties o rjury,that the i formation on th' application is true and complete- FIRM NAME: I.JCI ;,' LIC.NO.: Licensee: ignature (If applicable,enter"exempt"in the license number line.) Lil. NO.: . Address. -Z—% t\/tJL I re04_ Bus.Tel.No.: ,,,) .Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic. No. --I r -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. 7 Owner/Agent j Signature Telephone No. I PERMIT FEE: $ 7 --I