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Home My WebLink AboutBLDE-22-003556 Commonwealth of Official Use Only IL Massachusetts Permit No. BLDE-22-003556 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:12/27/2021 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) 8 DUTCHLAND DR Owner or Tenant Pamela Haskins Telephone No. Owner's Address 8 DUTCHLAND DRIVE,YARMOUTH PORT, MA 02675 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement furnace. 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 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices To No.of Ranges No.of Air Cond. Ton 1 No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent 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: ANDREW G THOMAS Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 ECHO LN,CHATHAM MA 02633 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 { ,yI jJ u Official Use Only commonweal&oil MadducAuse rr�� cc77 Permit No�2-- --3'D (4) " 2itparimsnl o�.�+ies-carvitsd Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] (leave blank) I APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12,00 l (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: be(_ a Cr, City or Town of: yet( (No vTin 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) ,gj D U`) (_t. l A h a D r t Y t Owner or Tenant 1 g n t I ct l4 G sk,n 1 Telephone No. Owner's Address .3 1)1/10. 10 51 D r t v t Is this permit in conjunction with a building permit? Yes 0 No it (Check Appropriate Box) Purpose of Building it 5, t n 4,e, Utility Authorization No. Existing Service -.),0 0_ Amps tit a / at40 Volts Overhead P1 Undgrd❑ No.of Meters t New Service Amps / Volts Overhead Undgrd [ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t C on n et,i t t.4'I ACtln t rt j 6;S IV(ft°`Lt. 7 h `S bv11{i }),S uflAlcrt. Completion of the followinktable may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers TotaKVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- No.of Emergency Lighting No.of Luminaires Swimming Pool grad. ❑ Rrnd. ❑ Battery Units No.of Receptacle Outlets I 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. Ton` No.of Alerting Devices No.of Waste Disposers Heat Pump Rumber Tons KW No.of Self-Contained po Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ 0ther Connection No.of Dryers Heating Appliances KW security Systems: No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices orEquivaient Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent .Telecommunications Wiring. No.R y _ OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (+1 °+u 0 (When required by municipal policy.) Work to Start: l'a/.14 ) 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 BOND 0 OTHER 0 (Specify:) I certify, under the paint and penalties of peijury,that the Inform on on this application is true and complete FIRM NAME: or AS Lit StrV'L'" 5^L LIC. )ta )5d 0 T Licensee: A.,J,rtV ZhoeV&c. SignatureLIC.NO.: (Ifapplicable,enter"exempt-in the license number line.), R i �� Bus.Tel.No.: 6P- 31e`• ?9) Address: C t 1{ 1 !►t+ 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: 1 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)0 owner ❑owner's agent. Owner/Agent Signature Telephone No._ PERMIT FEE: 5