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Home My WebLink AboutBLDE-20-005689 '‘ °10 Commonwealth of Official Use Only FAMassachusetts Permit No. BLDE-20-005689 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:5/5/2020 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform lectncal work d .b�. Location(Street&Number) 19 TOWN HALL AVE /`�d,J,(211 Owner or Tenant OSBORNE BRIAN A TeleXone No. Owner's Address 102 CONSTANCE AVE,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec r ' t 0 Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No. Pk/ '446,New Service Amps Volts Overhead ❑ Undgrd ❑ No.of eternIA/� Number of Feeders and Ampacity 47r n o Location and Nature of Proposed Electrical Work: Finish basement area. (CORY CLADY) 2f 40 Completion of the following table may be waidethe Inspector of Wires. No.of Recessed Luminaires 9 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- 1:1No.of Emergency Lighting grnd, grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners 1 FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and 2 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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: $75.00 - e 2`1 1] , , a Comosonuwoa[th oi7,7644/4,140.1Official Use Onlyly )• ?�i _ cc77 nn Permit No. 1:��"-5llJQ39 ■ �I JJsparfmant e/.. irs Jeruicsd 111,!'_ Occupancy and Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS Rev. 1107] (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 I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her/int,en�tion to perform the electrical work described below. Location(Street&Number) '7owA �l A-vt_ Owner or Tenant r, dr id., _ ,_sy Telephone No.5Da•2Z!•.�538' Owner's Address /9 % t}!) `r., / ,Q V,e�w Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building f)/S &a,spe/i� Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd El No.of Meters New Service Amps / Volts Overhead❑ Undgrd El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t ' d o �--�-- .1111 4111 . 3as einfiK vF Completion of the following table may be waived by the Inspector of Wires. ''i No.of Total lie No.of Recessed Luminaires q No.of Ceil.-Susp.(Paddle)Fans Transformers Z' No.of Luminaire Outlets 0 No.of Hot Tubs Generators ) KVA -r- No.of Luminaires 0 Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting � ond. grad. Battery Units (i' No.of Receptacle Outlets No.of Oil Burners 1. FIRE ALARMS No.of Zones No.of Switches No.of Gas Burnerso.of Detection and c Initiating Devices Ili No.of Ranges Cb No.of Air Cond. 0 TotalsNo.of Alerting Devices 0 Heat PumpNumber Tons KW No.of Self-Contained No.of Waste Disposers - D po Totals: .. _ .-....�...-._�.. Detection/Alertin�Devices Q, No.of Dishwashers 0 Space/Area Heating KW Local❑ Connection ❑ Other Y781 -0" clis, No.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of o.of Q Data Wiring: Heaters Signs o Ballasts No.of Devices or Equivalent O No.Hydromassage Bathtubs No.of Motors 0 Total HP TelecommunicationsofDevor qu!v � � No.of Devices Equivalent OTHER: GAttach 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. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless Sthe licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The is undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. qCHECK ONE: INSURANCE 0 BOND ❑ OTHER 0 (Specify:) G I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: g (!f applicable,enter"exempt"in the license number line.) Bus.Tel.No.; di Address: 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 ❑owner's agent. Owner/Agent �.!(.a . 'Lid'PERMIT FEE:$ Signature Telephone No / `y 1 1, U c . ) 7