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Home My WebLink AboutBLDE-19-005255 �� . /P C Official Use Only of Permit No. BLDE 19 005255 ` is„ ' 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:3/19/2019 City or Town of: YARMOUTH To the Inspector of Wires: 7it`Z32_ 1 1 GO By this application the undersigned gives notice of his or her intention to perform the el meal work ibed below. Location(Street&Number) 41 FISHING BROOK RD ( dLl(S Owner or Tenant KANE ANTHONY J Telephone No. Owner's Address 41 FISHING BROOK RD, SOUTH YARMOUTH, MA 02664 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 master bedroom. Completion of the.following table may be waived by the Inspector of Wires. 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 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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 ❑ BOND 0 OTHER ❑ (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 C-0. (05:r c(Q Cq &pa1 N - rti zt r�' 0 2- K (e +"t P ,met--c__ (2-c ( £ _ Commonwealth I.= __-. ///adsarhucselfs cial Use ly s+�-== 2eparEmcnt o f,7-ire Serviced Permit No. � L �C—�/�/ \. cs? --;- ' .-'-- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev- U07] Cleave blank) — -- APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Elecu-ical Code(MEC),527 CM 12.00 wPl EASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of: YARMOUTH i �1..�.,.�. — ��y' his application the undersigned To the Inspector of Wires: im gn gives notice of his or her intention to perform the electrical work described below. T,o' tion (Street&Number) 41 1' I.Sh a v tJ1/ k remo I--t '� ' `' '0 � er or Tenant � � N � "Ys'')� C_U l s - WI VA n ► A (;2e- YZ re rl Telephone�10. Z I� at LTa ® er's Address G I F;5111 y)a 130b0 I( led . S I A Y2 Yy-,O 01 ft Y'Y) /9 024 6 4 ., A ,tI s permit in conjunction with a building '► . � - permit. Yes No ❑ (Check Appropriate Box) 1 Iu P:urp6se of Building Ate al AsfiP✓ Oectll QOM Ut ility Authorization No. ^w Efistng Service Amps / Volts Overhead E. grd. Und ❑ No.of Meters New Service Amps / Volts Overhead Und d n _ �1 I� I T❑ No.of Meters Number of Feeders and Ampacity f/ „t�t,aY l 1--(''lcul Location and Nature of Proposed Electrical Work: n/CtQ -e..r ,--1 rco r Completion of the following table may be waived by the Inspector of Wires. — No.of Recessed Luminaires No.of Cei1.-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- o.of Emergency Lighting rrnd arnd. ❑ Battery Units No.of Receptacle Outlets a No.of Oil Burners FIRE ALARMS 1No.of Zones No.of Switches a No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No. of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:I 1_ Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent F No. Hydromassa a Bathtubs No.of Motors Total HP g Telecommunications Wiring: ' OTHER: No.of Devices or Equivalent 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: INSURANCE COVERAGE: Unlesswaived by the owner, o permit fnspections to be requested in ocr the performance of electricalw completion. the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivork alentissu.unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OAR ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: LIC.NO.: Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: Address: Bus.Tel.No.: �_ J `Per M.G.L. c. 147,s.57-61,security work requires Department of Public SafeLicense: Alt.Tel.No.: r•OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not haveth bil Lic.No. required by law. By my signature below,I hereby waive thish'insurance coverage noun 0I Owner/Signature requirement Iam the(check one El owner ❑owner's a _ent. 1? - Telephone No. p PERMIT FEE: $ 7 c