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Home My WebLink AboutBLDE-19--07109 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-007109 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•6/18/2019 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 electncal work described below. Location(Street&Number) 15 MARION RD Owner or Tenant MARARIAN JEFFERSON S Telephone No. Owner's Address 10 JEFFERSON RD, NORTHBOROUGH, MA 01532 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Aprpropriate )1>F) AV �1S0 aGi� Purpose of Building Utility Authorization No. C ),,a�" fi4 1 Existing Service 100 Amps Volts Overhead 0 Undgrd 0 �Vo.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace service due to fire. 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. rnd. 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 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: Stephen M Childs Licensee: Stephen M Childs Signature LIC.NO.: 32325 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 145 CAMMETT RD, MARSTONS MLS MA 026481519 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 Commorswsa o////assaca (tis .- Official Use Only i• _ Ar/ ter., c�77� [� �y-� „, = 2epari arrt o/.Tire Serviced Permit No.( 9 'I L((J'7 N _ BOARD OF ARE PREVENTION REGULATIONS eV. l/0 and Fee Checked •�.' Rev. i/07) (leave blank) '' z ,' APPLICATION FOR-PERMIT TO PER FORM RFORM ELECTRICAL WORK )_ All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 12.00 PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: C. / S/ oCO l City or Town of: YARMOUTH To the Inspector of Wires_ - -- By this application the pndersigned gives notice of his or her intention to rform the electri wej described belay: Location (Street&Number / 5 /yam4 /o rey jv -7 /'crX'/%7G✓ (. Owner"or Tenant �E !- , l?ejC( /�/-) Telephone ep a No. Owner's Address art ,7-7 c Is this permit in conjun on with a building b 4 Yes ❑ (Check Appropriate Box) Purpose of Building •i/ ��l/�l n 7 Utility Authorization No. Existing SerFdc / Amps 7-c&//2 Volts Overhead [ Undgrd ❑ No.of Meters / New Service /t2 ' Amps C/ 1/ Volts Overhead[ Undgrd ❑ No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f Ci f 4/7y} re,eeltC [� d U-P o f --/t o �o��P Completion of the following table may be waived by the Inspector of Wirer. No.of Recessed Luminaires No.of Ces1.-Susp.(Paddle)Fans No.of Total Luminaires Transformers ICVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1No,of Emergency Lighting - ernd,. mid_ 0 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 Initiating Devices Total 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: l Detection/Alerting Devi ces No.of Dishwashers Space/Area Heating KW I,°c111❑ Municipal Connection ❑ Other % No.of Dryers Heating Appliances KW 'Security Systems:* �, No.of Water No.of No.of Devices or Equivalent ••- No.of Z Heaters �' Data Wiring: - Signs Ballasts No.of Devices or Equivalent No,Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent _ MAttach 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 covers is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [ gpND ❑ OTHER ❑ (Specify:) I certify, under the p and penalties op erj ry,that the information on this application is true and complete / 3 FIRM NAME: , -Pl)/(`/.' /�`L12/ -) , 5g .tee LIC.NO.:� Licensee: Signature --'— (*) Ifapplicable.ent�rs�ps "in the license line.) LIC.NO.: Address. ``Tt 72 2 �/'y t- eS 6/, s� %-7 ,f,4-`�O,i.. i"/ Bus.Tel.No.: v ^�/� ,J `Per M.G-L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt)ricTeh No. — OWNER'S INSURANCE WAIVER: I 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)❑owner ❑owner's a-ent. , Owner/Agent Signature Telephone No. [PERMIT FEE: $ o�