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Home My WebLink AboutUntitled Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-002273 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:10/23/2019 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) 96 WAMPANOAG RD Owner or Tenant PERSAMPIERI NICHOLAS F Telephone No. Owner's Address PERSAMPIERI ELIZABETH M,96 WAMPANOAG,SOUTH YARMOUTH, MA 02664 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: Replacement boiler. 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 1 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 ❑ 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 ❑ 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: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN, WEST YARMOUTH MA 026733818 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 Geij C(Tt (9 l Commonwealth of Haut th • Official Use Only `i.,1 apartment o/.7ire Servicss Permit No. v Z�--� - ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,'[Rev. 1/07) (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELEC RIC L WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Inspec r of Tres: By this application the Trndersigned es notice of his or her intention to perform the el work described below. Location(Street&Number) ?,6 Whl, /)� 04 Owner or Tenant W6P " ' � '�/t/n� f. Telephone No.Owner's Address s (). /7/ Is this permit in conjunction with a buildingpermit? Yes ❑ No (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: D eti iti:4,,,,-,„ OCompletion of the follawingtable may be waived by the Inspector of Wires. No.of Cer1.Snsp.(Paddle)Fans Total No.of Recessed Luminaires Transformers KVA No. of Lnminaire Outlets No.of Hot Tubs Generators K TA No.of Luminaires Swimming pool Above ❑ In.. D 1vo.of i.mergency Lighting _ =rod.. arnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS JNo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices -� No.of Ranges Total No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I j Tons (KW No.of Self-Contained Totals: I Deteciion/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Q Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters ' No.of 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 Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Workk (WhenWork to Start: required by municipal policy.) 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 tinBOND ❑ OTHER. ❑ (Specify:) I Ce1tifr, under the pains and penalties ofperlury,that the information on this application is true and complete. FIRM NAME: Licensee: I��►� / /LIC.NO.: ni - . '��/t/a�� J Signature .'%:/4/,/�arZfliII=i% IC.NO.: Address: , I. i /;ii/A / Bus.Tel.No.. �, 7/ j .Per M.G.L. c. 147,s. -61,security work requires aepartment of'�birc Safe Alt.Tel.No.: - OWNER'S INSURANCE WAIVER: I am aware, at the Licensee does not have the liabilityLin.No. 5 required by law. By my signature below,I hereby waive this uisurwc�coverow notm�' Owner/Agent requirement Iam the(check one 0 ❑owner's a ent Signature >)(i Telephone No. PERMIT FEE: $9)--