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Home My WebLink AboutBLDE-22-001779 0 t Commonwealth of Official Use Only Permit No. BLDE-22-001779 Massachusetts ....II BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1Rev.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:9/28/2021 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) 73 CHRISTMAS WAY Owner or Tenant FOX PHYLLIS A Telephone No. Owner's Address 73 CHRISTMAS WAY,SOUTH YARMOUTH, MA 02664 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 gNo.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring of bedroom&bath addition. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 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 16 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection 0 Other: No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Ballasts Data Wiring: Siens No.of Devics or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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: JESSE R OTIS Licensee: JESSE R OTIS Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 22145 Address:94 OLD CHATHAM RD, BREWSTER MA 026311979 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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)) ❑ owner ❑ owner's agent.Owner/Agent Signature Telephone No. 'PERMIT FEE: $75.00 I 12 0 t)-(att Q13o 114t qt‘,..\fit(46 hc2):), Ce_is n Comnzonavealth o/Vaddachudetid Official Use Only=' 6=2 �' {— c� c� Permit No. in— y ahepartment o/.}ire Serviced t e Occupancy and Fee Checked = .e BOARD OF FIRE PREVENTION REGULATIONS ,,a' [Rev. 1l07] s, (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TY ALL INFORMATION) Date: 2r City or Town of: IUfrial To the Ins ecto of Wires: By this application the undersigne gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) j Clko imc J 1,1.4y— Owner or Tenant a/Ile f� Telephone No. Owner's Address Is this permit in conjunctio th a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building � Utility Authorization No. Existing Service/CO Amps /20 /ZYO Volts Overhead 0 Undgrd[kr No.of Meters ( New Service Amps I Volts Overhead❑ Undgrd g 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /{fit M.. of elicet /b_ 4 ' Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 16 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 5/ 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 /p 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 No.of Waste Disposers Heat Pump I Number I t Tons 1KW No.of Self Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal �❑ Connection ❑ er No.of Dryers / Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent No.of Heaters KW Data Wiring: 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 o Elec 'cal Work: �7/ (Whent) required by municipal policy.) Work to Start: Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OV E: 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 ov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) I certify,under the aims an enal ' o p ) L'_t{P f perjury,that the informs • non his application is true and completes FIRM N • - �jf t 1 7-2/ r S ' LIC.NO.: Licensee: r •P ,S Signature q (If applicable, r."exem t"'n th ease tuber line.) LIC.NO.: �'3�} / Address: Q� �� m /Y7 f Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Publicbl Safety("S"License: Alt.LicTel.No. 5c�� 1 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 Owner/Agent one)❑owner ❑owner's agent. Signature Telephone No. I PERMIT FEE:$