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Home My WebLink AboutBlde-22-002990 uQ Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002990 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•11/23/2021 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) 938 ROUTE 6A Owner or Tenant Dale Orman Telephone No. Owner's Address 938 MAIN ST,YARMOUTH PORT, MA 02675-2172 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: Footing grounding 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 n No.of Alerting Devices 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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: ROBERT F THIBEAULT Licensee: Robert F Thibeault Signature LIC.NO.: 22475 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:36 GOVENOR BRADFORD RD, BREWSTER MA 026312806 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 my 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: $80.00 U� lit U-P- 103(241 • \= �o,nmorvaec(r}f o�/// �� (7fneial Use Only -7---H' ' a r---_ 1..... , : ` w � - pertrnrnt o�._7`iro Jcrvice:s Petmit No. f fir. r � . �. . Oceol any and Fee Checked /LIT: i `:. =c' BOARD OF FIRE PREVENTION REGULATIONS lRev. 1/07] eavebleatAPPLICATION FOR°PERMET TO PERFORM EL ECTRIGAL CORK ' All work to be performed in accordance with the Massachusetts Electrical Code(k1EC),527 CMR 12,D0 i, (PLEASE PRINT IN INK OR TYPE ALL INFORhS417ON) Date: /!/z��Z( ,..... .- ;' Cify or Town of: � _�� g To the Inspector of Wirer_By this application the pndersiped;fives notice of his or her intention to perr'o�the electrical wort,described below. Location (Street&Number) Y8 r (i9- Owner or Tenant p_A,€ 4 GON Telephone Na, Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No E (Check Appropriate Box) Purpose of Building Utility Authorization No. 68.E'-f3S Existing Service _o y Amps (L 0 / 2'OVolts Overhead �/ Un rd Lam" d�g ❑ No.of Meters (' New Service Amps / Volts Overhead T ❑ Undgrd ❑ Tto. of Meters Number of Feeders and Ampacity f—f oQ Location and Nature of Proposed Electrical Work foo<s26.-- . a/Z-OuND Carrrpletion of the folawtne.table may be waived by the Inspector of Wires No. o€Recessed Lrsmia:h Na.of Cer7 cusp.(Paddle)Fags No.of Total Transformers KyA No. of Luminaire Outlets No.of got Tubs Generators KVA ' Na. of Luminaires Swimming Pool move In- lNa.or.e;mergency 1,tracing n-nd.. � arnd. � IBattery IIaits Nei. of Receptacle Outlets Na.of Oil Earners !FIRE A.L.kR>'✓LS INa.of Zones No.of Switches No.of Gas B n-ners No.of Detection and "nit-eattna Devices No.of Ranges No.of Air Cond. Total - Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number 'Tons KW (Na.of Self-Contained Tot-PIT: , 1Detetdion/_SlertineDevices No.of Dishwashers SpacelArea Heating KW* Municipal Local Q Connection ❑ Offer No.of Dryers Heating Appliances Kt Security Systems:* No.of Water No.of Devices or Equivalent Heaters KWNo. of No. of Data Wiring Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Iip Telecommunications Wiring; O 1 HER: Na of Devices or Equivalent • Attach additional detail if deified or as required by the Inspector of Wires. Estimated Value of Electrical Work:. Work to Start (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule I0,and upon completion, INSIJRANC'E 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing of ce. The CHECK ONE: INSURANCE EgZ BOND ❑ OTHER 0 (Specify:) Con110/6,t-Ge P(2 / z I cuff, tinder the pains and perm/des ofperjmT, that the information on this appEcction is true and consp(ete. FIRM NAME: LIC.NO.: Licensee: p j g c.Y Signatart �-- Pf applicable,enter exempt in the license number line.) LIC N 0.:��t f�,'' Address �(J a�� p /�.GGWS/ i/�'1�7 • O 3( Bus.Tel.No: 33 7—�_ j 'Per M.G.L. c. 147, s 57-61,security work requires Department of Public SafetyS"License: Alt.TeL No.: O�'NER'S INSU " Lit.No. required by law. mNCE WAVER.. I am aware that the Licensee does not have the liability insurance coverage y signature below,I herebywaive this nr's a(ly Owner/Agent requirement I am the(check one ❑owner ❑owner's a cut Signature Telephone No. PERMIT FEE: S