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Home My WebLink AboutBLDE-23-000899 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-000899 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:8/18/2022 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) 10 PINE GROVE CEMETERY L Owner or Tenant GODZIK RICHARD Telephone No. Owner's Address GODZIK MICHELE, 16 HANSON RD,CHARLTON, MA 01507 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: Receptacle for microwave 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. rnd. Battery Units No.of Receptacle Outlets 1 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 on l No.of Alerting Devices 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 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 Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: Jack W Griffin Licensee: Jack W Griffin Signature LIC.NO.: 418 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:26 JOANNA DR, S YARMOUTH MA 026641339 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: $50.00 oV IN3 , ,-4---.7. RECEI VED2. peCt AUG 1 s 2022 , ear el Ma Official Use Only ,44 ',: 14 !' ING DEPARTME((� �cc�� nn Permit No. _ "/ —0 d _1/414.L .0 aE o ,tint Serviced / Occupancy and Fee Checked • BOARD OF FIRE PREVENTION REGULATIONS [Itev, 1/07] (leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK W MI work to be performed in accordance with the Massachusetts Electrical Code( EC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S /C o?0\ V City or Town of: YARMOUTH To the Ins ector of Wires: By this application the undersigned gives notice ofliis or bet intention to perform the electrical work described below. U Location(Street&Number) / ) Y/Are) or o ,rG G Fm-c 7`1K A yf AJ -� _ Owner or Tenant , /(,11 4 R,D f Al)G � 6 O b 2 / Telephone No. 'Lki Owners Address /d /.I A i S Ot3 RD C h A rz 116 A 61367- /S3 b cz Is this permit in conjunction with a building permit? Yes 0 No A (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 Aetdty r- nu , Location and Nature of Proposed Electrical Work: ql,,2 A, In,c x.6 ,,t,,g1p-ems 0y Completion of thefollowingtable may be waived by the/ for of Wires. 111 No.of Recessed Luminaires No.of CeI.-Sasp..(Paddle)Fans No.of- Total ;/ ransformers KVA n. No.of Luminaire Outlets Na of Hot Tubs Generators KVA No.of Lundnaires $ Pool Above In- No.of Emergency Lighting g and. ❑ grad. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones , No.of Switches No.of Gas Burners -No.oTDetectlon and 4 Initiating Devices I No.of Ranges No.o Air Coed. Totali No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW "No.of Self-Contained Totals: _ `" Detection/Alertin Devices -I No.of Dishwashers Space/Area Heating KW Local❑ Manonna iron 0 Other No.of Dryers Heating Appliances KWSecurity Systems:* f Devices or Equivalent No.of Wters KW aterNo.of No.ofts Data Wiring: Sims Ballasts of Device!or Equivalent _ No.Hydromassage Bathtubs No.of Motors Total HP Tel No m Devicesf or Equivalent m i ns�W Wiling: t OTHER: Estimated Value of�lectri Work: Attach additional detail tf desired,or as required by the Inspector of Wires, Work to Start: g i sA� Inspections to be requested required by municipal policy.)sted 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 collage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND 0 OTHER 0 (Specify:) I eerie,under the pains and penaides o ped that the information on this application is true and complet (-' FIRM NAME r�rc-)..-(,1C., ir, iut l N LIC.NO.: i_ 'I I Licensee: o--e I'> G r, it t I• Signature LIC.NO.: A.2 S 9/9 (If applicable.utter' pt"in the novas numb,line.) aBus.TeL No.: 9` tr Y7 9 , �Z) Address: p'�l✓O o I!o.IN A Ai /II OIJAI 4 ji o�c,P / Alt.TeL No.: *Per M.G.L.c. 147,s.57-61,security work requi es Department of lic .f' "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 agent. Owner/Signature t Telephone No. (PERMIT FEE:$ S() H