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Home My WebLink AboutBlde-19-001168 r or l' ' Massachusetts Commonwealth of '� Official Use Only Permit No. BLDE-19-001168 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:8/27/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives no ice o is or er in en ion to pe onn e e n work describe a Location(Street&Number) 201 PINE GROVE RD 1C � 1 :51\ Owner or Tenant Telephone No. Owner's Address EILEEN M Is this permit in conjunction ' h`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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Receptacle for washer/dryer. 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 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 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: Michael D Guertin Licensee: Michael D Guertin Signature LIC.NO.: 51373 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 HEATHCLIFF RD,SOUTH DENNIS MA 02660 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 C @l 13(24< gto Common w yyyy��off///assachadetti • Official Use Only i. - i/ cam. �7 /�, l�f=- = 2eparfineni 4 ire Services Permit No. �-j ^-7/ ��_ =`r=�- '• ' Occupancy and Fee Checked • 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 C),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: , //I City or Town of: YARMOUTH To the Inspector of Wires: By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 0/ , w i E 6—RO Vt f Owner or Tenant �j '� ,6�� ,1 Telephone N , , Owner's Address Is this permit in conjunction with a building permit? Yes E No 74 (Check Appropriate Box) Purpose of Building Utility Authorization No. 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: //Uc7i�/( ,(,aw e mG°,e,,'TS forz_ $7efc,Le D to fSke D iele,c_ . • No.of Recessed Luminaires KVA Completion of the following table leomay be waived by the Inspector of Wires. No.of Cell.-Susp.(Paddle)Fans Total Transformers KV _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. Qtnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals; Detection/Alerting Devices No.of Dishwashersi' Space/Area Heating KW' Loral❑ Municipal Connection ❑ otherNo.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.Signs Ballasts Data Wiring: _ No.of Devices or Equivalent No. Hydromass age Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent It J �� Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o:Zeal Work Work to Start � S (When required by municipal policy.) WSURANCE C Inspections to be requested in accordance with MEC Rule I0,and upon completion. GE: 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 [Xi BOND ❑ OTHER 0 (Specify:) 11 I certify, under the pains and penalnps of perjury,that the information on this application is true and complete. FIRM NAME: /41 c.hi EL y, (rc e e--T/&) Le I y1Q/Q(4 J Licensee: jYj 1 (T��7 Signatur LIC.NO.:—_ '' (If rites"exempt"in the license number line.) LIC.NO.: 3 Z.. Address.applicable, /(P.6drKP Ls FF /e P S�/c,! /J /vIs �K )�(p�a 0 Bus.Tel.No. 7,1 yp j "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lic. No.. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�— 5 required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner Owner/Agent0 owner's a eat Signature Telephone No. PERMIT FEE: $