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Home My WebLink AboutBLDE-22-002168 r - Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002168 _ 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:10/15/2021 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 INGRAM SAMUEL P Telephone No. Owner's Address 938 MAIN ST,YARMOUTH PORT, MA 02675-217214 --1� Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box s,5 ue... Purpose of Building Utility Authorization No. 6854355J Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Temporary service off pole 108/3. 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tuns No.of Waste Disposers Heat Pump Number Tons K\1 No.of Self-Contained 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 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 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 eta 10 ri (klizl.-1, -9 s'tf'Pp , 1-4-t 00 ) • l.om.morzticdth of ///0-66aciiV4CE6 • Omciel Use Only ❑ f- —�� c--��, cc-7 nn Permit No. ,ts- >ie z e = �_ 2cpart r t of iry Scrvirrl BOARD OF FIRE PREVENTION REGULATIONS Occ¢p0cy and Fee Checked) N i¢ `* fRev. 1/D7] (leave blanl) w� an ,a- APPLICATION FOR°PERMIT TO PERFORM ELECTRICAL WORK •--i O ' 4ll wort;to be f -- Operronned in accordance with floe Massaebusetu Electrical Code(MEC),527 Chia 12.D0 (t ov o (PLEASE PRINT 1N MIK OR TYPE ALL INFORM,4TION) D ate: /�/Z--, / I City or Tower of: YARVIDL-'I'H LY By this a To the Inspector of Wises: m 'application the pndersiped Ejves notice of his or her intention to perform the electrical work described below. Location (Street&Number) • .giZ - 3 6-/ Own er'or Tenant ,32 0 420iV Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No (Check Appropriate Bon) Purpose of Building Utility Authorization No.6 62, --- Y355" Existing Service Amps / Volts Overhead Undgrd No.of Meters New Service /00 Amps /ZO /Z10 Volts Overhead Undgrd No. of Meters I Number of Feeders and Ampacity / ---- /00 Location and Nature of Proposed Electrical Work:: /.705j _ �0D Completion of the following table may be w&ved by the Inspector of Wires. No, of Recessed Luminair es No. of Gel-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlet No.of Rot Tubs - Generators KVA `� No. of Luminaires Above. Ln- Nn,of tame s g- Swimming Pool it cY L ignIIng Qrnd_ � acrid_ � Rsttery IInits No. of Receptacle Out at No. of Oil Burners IFLh.E ALARMS No. of Zones No. of Switches No.of Gas Barns No.of Detection and Lnitiatinu Devices No. of Ranges No. of Air Cond. Total Tons IND. of Alerting Devices Heat Pump Number Tons IKW No. of Self Contained Totals: I (Detection/A.lerting Devi No.of Waste Disposers ces No. of Dishwashers Space/Area Heating KW* Local Q Municipal _ Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No.of Devices or Equivalent Heaters ).'W No. of No. of Data Wiring: Signs BallastsNo.of Devices or Equivalent ' No. Hydromassage Bathtubs No. of Motors Total HP Telecommutucatsons Wirmg; OTFFR: No.of Devices or Equivalent - • • Attach additional detail f desired or as required by the Inspector of?Fires. Estimated Value of Electrical Wort (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 the licensee provides proof of liability insurance inclucimg"completed operation"coverage or its substantial equivalent The undersigned certifies that such cove e is in force, and)1Pe exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE I certify, urzder the pairs and penaltieo ND El OTHER D (Specify.)(�brn/3're4LCE r/lZz.(aZ fpefury, that the information on this appTcatian is true and complete. FIRM NAME: LIC NO.: Licensee: D13 �Li Signat�r�-- NO.:___________ Licensee: enter exem t in the license number line.) LIC.NO.: c f�� Address. .7�(-Gt/.( /Z,9>�v9 / e/Z m,4-5,S, O�6-3 ( But Tel.No:S�R•,��7 6�3q J 'Per M G.L. c. 147, s. 57-61,security work requires Department of Public SafetyAlt Tel No.: -- OWNER'S INSURANCE WA "S" License: Lic.No. �z bylaw. myWAIVER-- I am aware that the Licensee does nor have the liability insurance coverage normallyBy signature below, I hereby waive this requirement I am the(check one ❑ owner Owner/Agentod c �'s a �t Signature Telephone No. PERMIT FEE: $