The URL can be used to link to this page

Home My WebLink Aboutblde-20-002761 Commonwealth of Official Use Only -` 1 Massachusetts Permit No. BLDE-20-002761 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:11/12/2019 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) 35 MAUSHOPS PATH Owner or Tenant Telephone No. Owner's Address ,35 MAUSHOPS PATH,WEST YARMOUTH, MA 02673 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: Replace meter socket&service drop due to tree damage. 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 Initiatintt 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 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: MATTHEW F OSTROWSKI Licensee: Matthew F Ostrowski Signature LIC.NO.: 17228 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:71 LOTHROPS LN,W BARNSTABLE MA 026681354 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 ��! it ( 2o (i (� 22-1 (o3g5) A cv,‘ (rkp lJiyks �I Commonwealth o//r/addachiadalld Official Use Only 't c7 Permit No. e2-O 6 -� + 2sparlmand of Jiro�srviced Occupancy and Fee Checked • 6J I , BOARD OF FIRE PREVENTION REGULATIONS [Rev. 107]y (leave blank) 4 'APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 CMR 12.00 "`"` (PLEASE PRINT IN INK OR TYPE ALL INFORMA77ON) Date: j/ i 2- /�' %1 City YARMOUTH p� of Ci or Town of: To the Ins ctor Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. `I Location(Street&Number) 35 im,A-oS Hp P P'-'T 1-ii W: Yf{4.4140;..) LL C) Owner or Tenant 1:'ki {-E-r4-j f Telephone No. Owner's Address cey'_ - - Is this permit in conjunction with a building permit? Yes ❑ No, (Check Appropriate Box) a ': Purpose of Building Si,..)(7-1.a_ ' .4-t,,.t) Utility Authorization No. Existing Service /00 Amps /Lv/`;,f Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Q; Number of Feeders and Ampacity ~ ----7 Location and Nature of Proposed Electrical Work: R.0 PL,q-e_e like 2 -ice f1 , .S E 21/41,C_¢- •D R-o P ..--s' ''j! 4:t-L ' b 7►2-e=-' Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA y No.of Luminaires Swimming Pool_Above ❑ In- ❑ No.of Emergency Lighting rnd. 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 Initiating Devices {= No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices y No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection ❑ Other 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 Stan: l/�!Y /' Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE Cbb GE: 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 verage 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 ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: if, OST&tiStr> .Z AJCC, LIC.NO.: / 7 L Z b y- /J -e.0 Licensee: , � CicsLj— ,. /L Signature `� ( ) LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:7 7y—99 4/'Gi/2-- Address: 7/ Li.:.)T/'ie-0 p S t.-'W LL7. . 4/Lt-)ST 6 h(v Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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 0 owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 5