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Home My WebLink AboutBlde-20-002486 � Commonwealth of Official Use Only ki,� ► Massachusetts Permit No. BLDE-20-002486 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:10/30/2019 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) 66 JOSHUA BAKER RD Owner or Tenant CAMPBELL MICHAEL J Telephone No. Owner's Address CAMPBELL MARIA K, 6 SANTUIT LN, MASHPEE, MA 02649 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 ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ 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 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Securiq,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: BRIAN A SMITH Licensee: Brian A Smith Signature LIC.NO.: 24307 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:20 GELDING CIR, BARNSTABLE MA 026301503 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 S a i [ Comaioruusaeh o/ma t lac tb ,,..,• Official Use Only ui=- ri ry, 4 63 (:, L D i N G [ I_ .1JaParins¢nf o f.firs�arvicss Permit No. Z- 1 �/ n� - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked .t/ y • [Rev. 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 r�(vy (PLEAS''PRINT IN INK OR TYPE ALL INFORM4Tl019 Date: (1 QV City or Town of: YAR1VIOUTH To the Inspector of Wires: 352,`t�" By this application the undersigned gives notice of his or her intention to perform the electrical workdescribed below. Location (Street&Number) �� Owner or Tenant /i/ (', &// Telephone No. Owner's Address l i Jf7 /./N4 Is this permit in conjunction with a building g permit? Yes ❑ No Er (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters — New Service //JJ Amps /A) / pyoVolts Overhead E Undgrd / g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W/4 , 9 /,_i Aa*/,xc. / /_ 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 Srnd.. grad. 0 Battery Units No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices t No.of Waste Disposers Heat Pump Number No.of Self-Contained — Totals:I I Tons KW Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW• Local Municipal k ❑Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters No.of Data Wiring: KW Sighs Ballasts No.of Devices or Equivalent • No.Hydromassage Bathtubs No.of Motors Total HP g: Telecommunications Wirin OTHER: No.of Devices or Equivalent 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. 1` 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 cove ge is in force,and has exhibited proof of same to the permit issuing office. k CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:) \l` I certify, under th��srand nol• v of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.:/•r A Licensee: (.5 7� Signature 417(If applicable,en ere 't"in the license number/in ) LIC.NO.: Address: ��=—tee/`f e!/�� p f ` Bus.Tel.No.• �: �i �1�^ J `Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No. Tel. •� - OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage n — rnally S required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner [Downer's agent Owner/Agent ,) Signature Telephone No. ( PERMIT FEE: $ �(�-�, lr