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Home My WebLink AboutBlde-19-004579 V Commonwealth of Official Use only Xit.E- Massachusetts Permit No. BLDE-19-004579 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:2/11/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described belpw. Location(Street&Number) 98 CLEAR BROOK RD aosevrt ►Ag\iq Owner or Tenant Telephone No. Owner's Address ,WEST YARMOUTH, MA 02673 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 kitchen, ceiling fan, &outside lights. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 No.of Total Transformers KVA No.of Luminaire Outlets 7 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 14 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 8 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 1 Space/Area Heating KW Local ❑ 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 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:$75.00 • y7-4if C-(1\144_ (011 �telc Commonwealth oI f a /uietta Official Use Only -, _ t cc�� cc77 /`�- Permit No. �ck—'* '79 C °)_ ; 2epartment of ire Serviced _.��_ y Occupancy and Fee Checked-iv,,� +e BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2 11—/99 City or Town of: Yr v,74 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 91C. Cetis '&AcksX 'l `J;(11q{yv1r,3LI-1-i, Owner or Tenant �dSC?p, Zznp Telephone No. /--5 j Q ��. Owner's Address I ✓� Is this permit in conjunction with a building permit? Yes ❑ No Dr (Check Appropriate Box) Purpose of Building 4 vse Utility Authorization No. Existing Service /x) Amps Z716/Gee6 Volts Overhead Undgrd❑ No.of Meters J New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: iii e ii , icikA,it - 3j-ove// ;c f Gf LC! h Q.fv ; 0,66 3- r i C/ks1 NPr� RV...Ce sc L. ithA . Ir ce Ce//) tl 6' , p�-oc�i$i C. /..i iv7 - Completi n of thqbllowing ble may be wain by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: p•(Paddle addle F Tf Total V) ans � Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 7 SwimmingPool Above In- No.of Emergency Lighting grnd. ❑ gIrnd. ❑ Battery Units No.of Receptacle Outlets /41 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches F No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of AlertingDevices No.of Waste Disposers Heat Pump Number Tons KW No.of Sell:Contained Totals: '�- Detection/Alerting Devices No.of Dishwashers i Space/Area Heating KW Local❑ Municipal ❑ Connection Other No.of Dryers Heating Appliances , Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Eckuivalent 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: 4"7,�j -- (When required by municipal policy.) Work to Start: oZ/p—/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 El (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Sig tore LIC.NO.: afapplicable, enter "exempt"in the license number line.) _-- us.Tel.No.;(5 -737-5007,E Address: Alt.Tel.No.: *Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WANERp I am aware that the Licensee does not have the liability insurance coverage normally required by law. By Mi atu" low,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent %- `" Signature ( . ''` --'' Telephone No. 1 PERMIT FEE: $