HomeMy WebLinkAboutBlde-18-005730 V
iti*or Commonwealth of Official Use Only
Permit No. BLDE-18-005730
Massachusetts
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:4/12/2018
City or Town of: YARMOUTH To the Inspecto f Wires.
By this application the undersigned gives notice o is or er men ion to pe orm t ctrica work described bel .
Location(Street&Number) 141 SEAVIEW AVE etQ4 O/t/T'l L
Owner or Tenant HOFFMAN CHRISTINE M Te ephone No.
Owner's Address 131 SEAVEIW AVE, SOUTH YARMOUTH, MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check s 4• , to Box)
Purpose of Building Utility Authorization N dtb
Existing Service Amps Volts Overhead 0 Undgrd . • Ali, • •
New Service Amps Volts Overhead 0 Undgrd 0 O. ' .
Number of Feeders and Ampacity 0 ,
Location and Nature of Proposed Electrical Work: Replace panel , plugs, &switches. O
Completion of the following table may be w. , , ° ctor of Wires.
No.of Recessed Luminaires 6 No.of Ceil:Susp.(Paddle)Fans 2 No.of tal
Transformers A
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 10 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 5 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges 1 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 1 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:
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. PERMIT FEE: $75.00
4
foruron;ur-,Al: oI2&t..'cr/..u_3ete OIDeial Ilse Daly
�� S
Permit No. �' 5
_2cPert'•n�nt of s-,:servi:eJ ,l
BOARD OF FIRE PP,EVNTION REGULATIONS OocTancy and Fee Checked _�_
]1''-,ev. 1/07] (.1ezve b1u3r11;)
APPLICATION FORPERMIT TO PERFORM ELECTRICAL WORK
All work to be pe,formes in accordance with the Massachusem Electrical Cade, C),527 Cla 1 ZDO
(P SE PRINT_1NLN_KOR TYPE AT.I INFORMATION) Date: - to/Va
City or Town. of: YA._MQ j,1`g To the I ecto of Wires:
€ . By this application the undersicied uives notice of his or bet intention to perr'om the electrical work described below.
•
Location (Street&Number) /f/ ,a c//fv/ /IBC
IN
Owner or Tenant A/cn,p8 6eA'r/(er Telephone No. 4 ec:
._. Owner's Address /%/ C�,Di/1�/k/ 4 IG / �� �
. _.. __ Is this permit in conjunction with a building permit? Yes V/' No _
(Check Appropri_te Bar)
_-- _ Purpose of GuiIRin Unity Authorization No,
-z Di-sting arTice � � =�Fs /L� I �'��Volts Overiead� Un ,Trd E No. of Meters
i •, hew Se •nce .A-mps / Volts Overhead❑ Undgrd " No. of Meters
Number of Feeders and Ampacity
i = i Location and Na¢re of Proposed Electrical Word 2
s w,TlZl
Corrtp! ion of the fo>Tawinz table may be.wthved by the Irsp_cuor of Wires.
Na. of Recessed Lnr—n y-es 67 Na. of C rl-SttsL
p.(Paddle)Fans - No.or Total
Transforms b'YA
No. of Luminaire.Ounle'3 No.of Hot Tubs
Generators b�'A
No. of LuminairesS Above la- nn.ai Emerg cy 12_ Mn;
wfm mittg Panl mod. ❑ _�rnd. Eat.rQ Unit
No. of Receptacle Outlets / 0 No. of Oil Burners R ALL ARMS No. of Zones
No, of Switches No. of Gas Euru±ss • iNti of Deteciinn and
Luirtia�Devices
No. of Ranges / No_ of Air Cond. Tonsl *,of 4lerZztg Devices
No.of Waste Disposers He=t p Number ITons IKW ((No.of Self-Col:7Tmed
�� Totals: I I iDeteetion/Alerana Devices
.� No. of Dishwashers SFace/Area Heatin, k-W iT-4.c2-1❑ 24lttrttczpal
P E of
�` No.of D Coan_ttion
VDryers Heatizrg Appliances Security Systems:T
\,, No. of Water No.of Devices or Equivalent
Heaters KW No. of No.of Data Wiring:
Signs Ballast
'� No.of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring;
OTARR:
No.of Devices or Equivalent
—
•
•
Attach additional detail irdesired or as required by the Inspector of FYires.
Estimated Value of Electrical W �
K.-
DI-k � /�QII (When required by municipal policy.)
Work to Start: Y i L zc'f) 1= ction5 to be requested in accorriance with MEC Rule 1 D,and upon completion.
INSURANCE CO RAGE: 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 equivalent The
C undersigned certifies th?t such coverage is in force,and has exhibited proof of same to theme PG.iuit issuing once,
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER [ iS ci a1Z0/1 'l
r7ify,I ce , tznder the pains and penalties Pe IY)
p s of p zuy, that the information on this application is true and complete.
FIRM NAME:
LIC.NO.:
L �_Licensee:
Signature LIC.NO.:
,` (If applicable, enter "ezempt"in the license number fine.)
Address: Bus.Tel.No.-
j Per M G.L. c, 147 s.57-61, ectuity work re ires Department of Public Safe Alt Tel.No.:
OWNER'S LI�tSUR�I� „S License: Lic.l�o.
� AIVE : I am aware that the Licensee does not have the liability ins nce coverage normally
S required by law. By s� slgnato4e 'low, I hereby waive this r ❑l' .i� Y equirement I azn the check one [ ourner
4 Owner/agent_ ) owner's a ent
5iga attrre /
01 TeIeplzone No.J�/t �'P 6,4)17 PERMIT FEE: S