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Home My WebLink AboutBLDE-20-002353 Commonwealth of Official Use Only � 4y� Massachusetts Permit No. BLDE-20-002353 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:10/28/2019 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 below. Location(Street&Number) 34 DRAKE ST Owner or Tenant SWENSON SANDRA L Telephone No. Owner's Address 9329 MAINSAIL DR, BURKE,VA 22015 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: Repair kitchen wiring. 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/Alerting Devices No.of Dishwashers 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 Siens 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Mark H Chase Licensee: Mark H Chase Signature LIC.NO.: 8669 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:21 DRAKE ST,YARMOUTH PORT MA 026752204 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 63EiD. toi Cci' • • Commonwealth off///assacheusslfe :,_.,: Official Use Only Permit No. c� c�77 n�! ' 235 .3 ; r1- T e arfinent°I,]ire Serviced - ''.-7- BOARD OF FIRE PREVENTION REGULATIONS [Rev. �and Fee Checked o :r (leave blank) -- c� f APPLICATION FOR P RMIT TO PERFORM I _c , All work to be performed in accordance with the Massachusetts F ELECTRICAL WORK (MEC),527 AMR 12.00 C. Z LEASE PRINT IN INK OR TYP�j ALL INFORMATION) Date: /G,„2 e i y I w ° City or Town of: I ikAp 7O u ( To the Inspector of Wires: le Iny this application the undersigned gives notice of his or her intention to perform the electrical work o k described below. w- �.._Location(Street&Number) 3 y .)/ C Owner or Tenant ``j pAjj SxreAssed Telephone No.'703 Y32-74 y. , kr--) 4, Owner's Address .3 y k e jf }/ 010-J aetl 440. ez e Is this permit in conjunction witha building permit? Yes ❑ No El (Check Appropriate Box) Purpose of Building /`e;;cle .yo,L Utility Authorization No. IQ Existing Service Amps / Volts Overhead D. Undgrd❑ 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: ge 141 ee 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.01 Emergency Lighting grnd. _grad. 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 Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ""��" .Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Loc Oth al❑ Municipal Connection ❑ � No.of Dryers Heating Appliances KW ecurity Systems:* No.of Water No.of No.of Devices or Equivalent ,. Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent gNo.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: s 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.) p Work to Start: Iornher Inspections to be requested in accordance with MEC Rule 10,and upon completion. v INSURANCE COVERA E: 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 —4 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:) h I certify, under the pains andpenalties o h f pe perjury,tha he in ormation on this application is true and complete. " FIRM NAME: C IS �S6, £Le et. C, 1�. .� LIC.NO.: 6 Licensee: A1 A gee e #45F, Signature Gt i niud�.. applicable. LIC.NO.: 17'�.(If pp cable,enter " empt"in the license number line.) f/ Address: P.O. Sr (I t't•( 5' beitJAA 1,14 A A. OZ64•0-1/l y Bus.Tel.No.: j "Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.Lic.T No. � _z �6 t18' — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragerage n�—required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent al Signature Telephone No. I PERMIT FEE: $ 5 0 I.