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Home My WebLink AboutBLDE-19-007142 o, '1 1 Commonwealth of Official Use Only L / Massachusetts Permit No. BLDE-19-007142 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:6/19/2019 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) 25 PEREGRINE LN Owner or Tenant MALONE BRIAN T Telephone No. _ Owner's Address MALONE KERRIE A, 11 MASSASOIT CIR, EAST WALPOLE, MA 02032 _ 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: Receptacle for stove&repairs. 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 ❑ 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjuty,that the information on this application is true and complete. FIRM NAME: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 51391 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 049 e7(3(&y i/ ri cir W d _ Commonwealth of 7444,te�eusetts • •i. Use Only 4/2_ ry� alA Permit No. '�r( ( _ . ` 1Jepartment o f J'ire Serviced t*�. _ BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked 1 --- ° °� ZRev. l/07) --__ =.�-; i' Ni (leave blank) . ► APPLICATION FOR-PERMIT TO PERFORM ELE TRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 12 00 " ! — tt (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ��" = City or Town of: YARMOUTH ; /2' � •:, c �' 44 To the I� for o Wires: By this application the undersigned gives notice offs or her intention to perform the electrical work described below. ` I Location(Street&Nu ber) • 1// Owner or Tenant f N �,-- Telephone No.2C 1--- Owner's Address DJ' 'r--(P'Cy d 1-4-b 11/Is this permit in conjunction with a b ding permit? Yes No �f ❑ � (Check Appropriate Box) e Purpose of Building Utility Authorization No. .- Existing Service Amps I Volts Overhead ❑ Undgrd ❑ No.of Meters 0 New Service Amps / Volts Overhead❑ Undgrd it ❑ No.of Meters Number of Feeders and Ampacity Location and Nature oof�ro/ Proposed /r Electrical Work: 44. 78` CA7,& // /2fJu < M �^rQ� � icti Completion of the follonvfng.table may be waived by the Inspector oTwires. c.) No.of Recessed Luminaires No.of CeB.-Susp.(Paddle)Fans No.of Total !` Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA _ No.of Luminaires swimming Pool �nd,e ❑ �d ❑ No.of L:mergency Lighting Batte Dnits n/ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Total Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices .� KWNo,of Waste Disposers Heat Pump I Number Tons W No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal _ Connection ❑ Other --' No.of Dryers HeatingAppliances , Security Systems:* 3 PP pst No.of Water No.of No.of Devices or Equivalent Heaters KW No.of 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; _ 1 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 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 ❑ (Specify:) I certify, under pen S \`y, the in nnatton or this application a and complet , /� FIRM NAME: t+�", ( 1 &t4 - LIC.NO.: C� ! ]L Licensee. j� • � t mil' e� Si afar Z� LIC.NO.: 3 (If applicable,_enter' t" tthe license number line.) Address A(j' �� ) '�!k /yi,, f-� Air Bus.TeL No.: r' 1p ,j Per M.G.L. c. 147,S.57-61,securitywork requiresDepartment 1 t u ` er "c Alt.TeL No.: Department of Public Safety"S"License: Lic.No. — OWNER'S INSURANCE WAIVER: 1 am aware that 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)0 owner ❑owner's agent 7 Owner/Agent I Signature Telephone No. LPERMIT FEE: $ 4-en