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Home My WebLink AboutBlde-20-000813 Commonwealth of Official Use Only te _ Massachusetts Permit No. BLDE-20-000813 BOARb 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:8/13/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 76 BAXTER AVE Owner or Tenant STREMPEK IRENE B(LIFE EST) Telephone No. Owner's Address STREMPEK MICHAEL(LIFE EST), 76 BAXTER AVE,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes ❑ 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. 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 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 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 ❑ 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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:$50.00 4 ) e(0670 i _ _ e mn onwe g o///lassac i Official Use Only m��=1 ' 1leparrmenf o f.dirt&mires Permit No. �J j = - __ ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRcv. 1/07] (leave blank) APPLICATION FOR-PERMIT TO PERFORM ELECTR AL WORK All work to be performed in accordance with the Massachusetts Electrical Code ),527 12.D0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Insp for o Wires: By this application the undersigned ' es n • e of . or her in 'o to perform the electrical work described below. • Location(Street&Numb r) .P. Owner or Tenant r-/�1 �' f4 1j Telephone No. Owner's Address / Is this permit in conjunctio with a tiding permit? Yes ❑ No ❑ (Check Appropriate Box) /A 1 Purpose of Building / ,.Q r//� Utility Authorization Na. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fe, it ei le et._ hi le,--, Completion oL'thefollawingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Col.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ElIn- ❑ No.of I~.mergency Lighting - ornd. acrid. 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 Iaitiatins Devices Total - No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump Number I Tons 1 KW 'No.of Self-Contained Totals: ` Detection/Alerting Devices No.of Dishwashers Space/Area Heating • Municipal KW• Local❑Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW 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 Wirer. 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 ' BOND ❑ OTHER 0 (Specify:) I certzfy, under the pains and penalties of perjtoy,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: �( Signature dZ i - .4 �' LIC.NO.: 0-applicable,e terempt" n the licensf um ) Address: �- j I /2 Bus.TeL No.: s / :' rA / Alt.Tel.No.: Q J *Per M.G.L. c. 147,s.57-6 security work requires D artmen of Pu rc a ty" "License: Lic.No. �t/ — OWNER'S INSURANCE WAIVER: I am aware the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent Owner/Agent 'l� Signature Telephone No. I PERMIT FEE: S 1