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Home My WebLink AboutBLDE-20-000632 • Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000632 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:8/5/2019 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) 15 SANDY LN Owner or Tenant GRANT MARILYN Telephone No. Owner's Address GRANT SALLY ANN, 33 TUFTS RD,WINCHESTER, MA 01890-1246 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 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: Replace SEU cable&meter socket. 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 Initiatine 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/Alertingt 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 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: Jeffrey T Foss Licensee: Jeffrey T Foss Signature LIC.NO.: 36938 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:33 SULLIVAN RD,W YARMOUTH MA 026733543 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 ---C3----f Cr . a //�� / mmonwsatth of Mp�44,4.tdttti Official Use Only l01 _ , Permit No.l 2epartment oil Sirs Servrcu % LCJ r D(Q 3 Z 0 w _ BOARD OF FIRE PREVENTION REGULATIONS Occupancy I/07] and Fee Checked y [Rev. 1/07] (leave blank) tij _> . o APPLICATION FOR=PERMfT TO PERFORM ELECT (CAL WORK a All work to be performed in accordance with the Massachusetts Electrical Code 27 2.00 uj ow ,� 'LEASE PRINT IN INK OR TYPE ALL INFORMATIONDate: f7 () V cE z City or Town of: YARMOUTH To the Inspec or o fires: L <o B1 this application the undersigned gives noti of hi or er in tion to perform the eclrical work described below. I m L cation (Street&Number) / 2 ��l /fr ��Wt- //J !®_ .. I ner or Tenant f�/�11A1 t / lrY� �/y 6S i9/�' - Telephone No Owners Address / '7 �� Is this permit in conjunction with a building permit? Yes ❑ No Fjq (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 101) Amps /A) / 62LAVolts Overhead, Und d tt' ❑ No.of Meters New Service Amps / Vohs • Overhead❑ Undgrd J�v gr ❑ No.of Meters Number of Feeders and Ampacity p 4 Location and Nature i 'rop..ed Electrical Work: da� Iffe rirei f A �- I) . s . l , MEV Completion of the following table may be waived by the Irupector 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 li mergency Lighting ::rnd. Qrnd. ❑ Battery Units No.of Receptacle Outlets No.of 0i1 Burners FIRE ALARMS No.of Zones 0 No.of Switches No.of Gas Burners No.of Detection and • Initiating Devices No.of RangesTotal No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat pump I Number Tons I KW No.of Self-Contained Totals: Detection/Alertmg Devices No.of Dishwashers ❑ Mai ' Space/Area Heating KW' Local Connuectiaion ❑ Other No.of Dryers Heating Appliances , Security Systems:* *\,. No.of Water No.of No.of Devices or Equivalent S Heaters ' No.of Data Wiring: Sighs Ballasts No.of Devices or Equivalent Q No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - OTHER: No.of Devices or Equivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of ctri a or]v (When required by municipal policy) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. Mitts INSURANCE CO G : 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 A) BOND ❑ OTHERCfay'4 ,( ,Ci^C � Ca, 4) Q I certify, under the pains and//pet��talties o 0 (Specify) r � 'i!`p/"�- N ��f perjury,that the information on this application is true and complete. FIRM NAME: Licensee: � LIC.NO.• �TTI��tT Signature �� (J Addressa(If ble. - - "exempt"i j tj e 2 e e num,.r ne.) `'� ��r LIC.NO.: s f� 1/��thianialiri: Bus.Tel.No.: �;fi" r- J Per M.G.L. 47,s.57-6 ,security wor requires Dcety Alt Tel.No.: .old-/� 6�J� c.No. required by law. OWNER'S INSURANCE WAIVER: I am aware that th�ccensee does not have the liability insurance overage n�or-mally "`/// S Owner/Agent By my signature below,I hereby waive this requirement I am the(check one 0 owner Elowner's a ent 0.1 Signature Telephone No. PERMIT FEE: $ 61j--