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Home My WebLink AboutBlde-19-002562 Commonwealth of Official Use Only Ems` Massachusetts Permit No. BLDE-19-002562 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:10/30/2018 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) 166 SPRINGER LN M r—1 f` P u Leg--- Owner or Tenant NEU STANLEY E Telephone No. Owner's Address NEU K DIANE, PO BOX 45, MANLIUS, NY 13104-0045 Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appro' Ube : x) , Purpose of Building Utility Authorization No. L 2 Existing Service Amps Volts Overhead 0 Undgrd 0 et . �' e New Service Amps Volts Overhead ❑ Undgrd ❑ �1 e . re Number of Feeders and Ampacity F Location and Nature of Proposed Electrical Work: Fire place insert,TV receptacle,&LED lights. 3P%s..) > Completion of the,following table may be waived A. of Wires. No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans No.of 0 Transformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 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 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 ❑ 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: JASON A CURRAN Licensee: Jason A Curran Signature LIC.NO.: 21794 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 TATNUCK GDNS,WORCESTER MA 016021220 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 4 4 IT t i I Z? / -- Coeunonwsailh of aa�sacsl� Official Use Only \, i• - --,t r d I ccam` = . )parfmartf / n Permit No. '—�� 2 BOARD OF FIRE PREVENTION REGULATIONSOccupancy[Rev. 1/07] and Fee Checked 1/07] (leave blank) 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: /p 2 et1/8 City or Town of: YARMOUTH To the I ec'tor of Wir By this application the undersigned gives notice of his or her intention to perform the electrical work described below. k ._) Location (Street&Number) /i'D at Sr r,',l,,er 14 vl e. OQ' Owner or Tenant Mar y E tte.h Z A p pu l Telephone No. �V -�oS�y-Z f' Owner's Address y h 's permit in conjunction with a building permit? Yes No El (Check Appropriate Box) " "'1u se of Building 5 3 t tY Utility Authorization N . 111 �" I x ting Service Amps / �, F Volts Overhead ❑. Undgrd 0 No.of Meters .,o �`e Service Amps / Volts Overhead El 0 No.of Meters l.0. > la ber of Feeders and Ampacity (,� I)roo Lion and Nature of Proposed Electrical Work: p t--- L o o � � iSf f'faor �i ui't� rao4., aA1 re d for 1v iL.I.�I u�+) e.} >< CsgS �':r�% (J14ct i�tser4 , ) f��de� 2K S" JeA1c4ivl. `'Odwort" mpletion of the following table may be waived by the Inspector of Wires. N •_-.-• - --Ne of Recessed Luminaires ) No.of CeiL-Soap.(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 ern&. atm& Battery Units No.of Receptacle Outlets )(Z No.of Oil Burners FERE ALARMS 1No.of Zones No.of Switches X i No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Totals:Heat Pump I Number I Tons I KW No,of Self-Contained Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mn Connectiouicipal n ❑ er 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: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 'T 1O . (When required by municipal policy.) Work to Start: /o /Zq //ti Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RA E: 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 c ge is in force,and has exhibited proof of same to the permit issuing office. ov CHECK ONE: INSURANCE BOND 0 OTHER DI (Specify:) I certify, under the pains and penalties ofperjuty,that the information on this application is true and complete. FIRM NAME:the 0,7 C r can M&f+a r (I I e c-f.r-;c i a.., r LL C LIC.NO.: �(`� Licensee: J as o r fah Signature Pam_ .t C (If applicable,enter "exempt"in the li;ccense number lint.) LIC.NO.: ( Q Address: 2 CrUSt S'('. you �qS ibti4 a!S-/(o Bus.Tel.No.: Tel.NoJ `Per M.G.L. c. 147,s.57-61,security work reires Department of Public Safety"S"License: Alt.Lic.No.�� - V - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norm S required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner Owner/Agent ❑owner's a ent I Signature Telephone No. PERMIT FEE: $