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Home My WebLink AboutBLDE-20-005678 Commonwealth of Official Use Only oir*I4 Massachusetts Permit No. BLDE-20-005678 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 the electrical work described below. Location(Street&Number) 20 BUCKWOOD DR -----1-1 Owner or Tenant Telep ne No. Owner's Address 20 BUCKWOOD DR, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check App., 1 • e ox) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 kit'k A _New Service Amps Volts Overhead ❑ Undgrd ❑ firnNumber of Feeders and Ampacity rzi Location and Nature of Proposed Electrical Work: Install service underground. Q Completion of the following table may be waived b • of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of �1 e� Transformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ElNo.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 Initiating 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 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:$50.00 jZk 5I7I-70 I 1�-C 4 or s/l t / -o 1L (bis co,v eVor)- Tie to /ZZ lAr.ri i 14 Comasonweatp►o`Masssckmolis Official Use Only q •, Permit No. "6-i-Z0 --S-(in 0 Occupancy and Fee Checked I BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (lave blank) °' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All 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:} r, 1 I C Z O a C� City or Town of: I{A r 4o►n`\ To the Inspect�r of Wires: (n By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street do Number) `a O c3(ALkku 0 O Owner or Tenant sitA d o,! inn Yell L y Telephone No. SC -1 31-IQ S°r Owner's Address qO USC. w co C\ D r Is this permit in conjunction with a building permit? Yes ® No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. U Existing Service X Amps XO / Volts Overhead® Undgrd❑ No.of Meters _ �1 New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampadty • Location and Nature of Proposed Electrical Work: ?u`Cf v i l S.e,(v I Cit, LA n c4 C r 9 r01 ikeN A Vl Completion of the followingtable my be waived by the I r of Wires. "� No.of Total W No.of Recessed Luminaires No.of Cell.-Snsp.(Paddle)Fans Transformers KVA '=.'1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA t- No.of Luminaires Sig Pool Above ❑ In- ❑ lYo.or er>Units racy Lighting 4rnd. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices 11 I No.of Ranges No.of Air Cond. Total No.of Alerllng Devices Tons No.of Waste 'Rest Pump Number Tons KW „ 'No.of Self-Contained Totals: Number_ ._. _._ __ - Detection/ Devices No.of Dishwashers Space/Area Heating KW Local 0 Coenectioa 0 Other No.of Dryers Heating Appliances KWNa ofDevices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or trivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No, Devices or Eq�t 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: (2l S A P 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 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 cerbllJ',under the pains and penalties ofperjM',that the&formation on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (Ifapplicable,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: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By y : ' below,I hereby waive this requirement. I am the(check one)154 owner 0 owner's agent. Owner/Agent i Signature ,',t/ Telephone No. co$-131- PERMIT FEE:$ i25 el