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Home My WebLink AboutBld-18-006414 1 cet(1 Fovv l' op.i2z,i. ion/ (7/ .-� - yy� / / Commonweal of///a. acuwsffs • Official se Only -"' % '- L(2L �'= Permit No. !it 5 Apartment of. L Serviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �9 [Rev. 1/07] (leave blank) ��s.-.�__._ APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code� (MEC)-527 12.00 0 w PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Imo$ ' 1 City or Town of: YARMOUTH To the Inspec or of Tres: . R T.i y this application the pndersigned gives notice of 's or her intention o perform the electrical work described--Lii( below. As-. 1 ocation (Street&Number) � 3 r., r �i S--ftt c 3 (' 5 l } c� weer or Tenant / (�II ' /le.•�. !�r - �/ ��ry �/ Telephone No. � o wner'sAddress (� tp t�C�ft`_ c � Wf� A4e,__ 1 .__..,�._.�m this permit in conjunction with a building permit? Yes b N ,z4 , t..__ a, .ropriate Box) !.......-...., - m rpose of Building U. - c'' n l 66.46P Existing Service Amps / F Volts Overhead Q Un _ Al .r47 New Service �� Amps / Volts Overhead❑ Undgrd ❑ 1� Number of Feeders and Ampacity47, < '4 rcation and Nature of Proposed Electrical Work: ° f--- ak- ,o0,,,t,efec_ G,50 100, ,,,.r, (A.2. ,.......-- Co etion ofathe fo owing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cei1.-Susp.(Paddle)Fans No.of Total Transformers KVA Z. - v r No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad- grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones v No.of Switches No.of Gas Burners No.of Detection and Toial Initiadnx Devices NI No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump r Number I Tons KW No.of Self-Contained -II Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Oth7 4 No.of Dryers Heating Appliances , Security Systems:* �f No.of Water No.of No.of Devices or Equivalent 3 Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 3 3~ 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: 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 OND ❑ OTHER ❑ (Specify:) clk I certify, under the pains and penalties of perjury,that the in o ation n this application is and complete. FIRM NAME:La r W .kit L. ' +�r‘ f t � C LIC.NO.: 3�� - Licensee: c.. ( �� Q� kjignatureL LIC.NO.: . /SS/J;-_._(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address �� /`/ ( AM -� S ��G t I(J(' Alt.Tel.No.: �� C) J "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. r1 vt — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 7 7/ S required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent iSignature Telephone No. I PERMIT FEE: $ 5 ) .c- 1 I ,). r,�� ( J�� C�( leverd(7 ,, , lOrJ C/� fl��j1//��/// Official Use Only ' ommonwealth off addac ttd /� —=,t t /\7 Permit No. `�i- ap t _ __I_f_ 1 Occupancy and Fee Checked = =�t. BOARD OF ARE PREVENTION REGULATIONS {Rev. 1/07] (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK — m _ "- , All work to be performed in accordance with the Massachusetts Electrical Code(MEC)-527 12.00 11 0�"" -`"; 1, PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: f f c / 0 ul, N City or Town of: YA,,RMOUTH To the Inspec or of Tres: =�('l Q ';3y this application the vndersigned gives notice of 's or her intention o perform the electrical work described below. .'"I w Location (Street&Number) �f 3 r^• t �l .Q . to, tO h 5 Va r ti !' r Telephone No. "� c1 c7 owner or Tenant 1 t,,,, ,��, `�t�• !(�r��!'� ; Owner's Address t ✓C rT+ c� �,� ` . f i Is this permit in conjunction with a building permit. Yes No (Check Appropriate Box) .• /. et `°""'-y,.' n I Utility Authorization No. ��i �' —P-trrpose of Building �� Existing Service Amps / Volts Overhead ❑. Undgrd❑ No.of Mete ;7 5 • New Service Amps / Volts Overhead 0 Undgrd ❑ No,of Meters Number of Feeders and Ampacity v L cation and Nature of Proposed Electrical Work: 1 :.,tea-`_ Com etion o the o lawin table m be waived b the Inspector o Wires, o.of No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of L:mergency Lighting v No.of Luminaires Swimming Pool tad. ❑ mod. ❑ Battery Units --(- No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners •_ . _ Initiating Devices ,\g Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: — Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW 'Local❑ Connection ❑ HeatingAppliances KW Security Systems:* No.of DryersNo.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: ----- --- f 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: 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. V CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) I certify, under the pains and penalties of perjury that the in o mation n this application true and complete. FIRM NAME: l (" -�t! Gk l; e 1 c t r.o Jrl� LIC.NO.: 1 3 U� ��c. ,r n 's. CQ� signature LIC.NO.: 5-7 j I/�` Licensee: `, / (If applicable,enter"exempt"in the license number line.) L�J (Bus.Tel No.: -.-• ��to r, Address: A_,/ `� c �r G r��' Alt.Tel.No.: 5 J *Per M.G.L.c. 147,s.57-6i,security work requires Department of Public Safety"S"License: Lic.No. -7 — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not e(checke the lliaoitylins �wnernce coverage e,,, .normally /i q required by law. By my signature below,I hereby waive this requirement. r--, ♦ ! \ $ 1 I ill, "mg" alik4444cf% \ \