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Home My WebLink AboutBLDE-20-003676 °� 19 ° Commonwealth of Official Use Only t , y �; '1 Massachusetts Permit No. BLDE-20-003676 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) DTo the Inspector2/2020 By this application the undersigned gives notice of his or her intention to perform the electrical work d scribed below. of Wires: City or Town of: YARMOUTH Location(Street&Number) 164 DRIFTWOOD LN '�sS.5 (ems Owner or Tena Owner's Address Telephone No. Is this permit in conjunction with a building permit? JA bel Purpose of Building Yes ❑ No 0 �!�"' Amps Utility Authorize on No.,Existing Service Am P Volts Overhead 0 UndgrI ❑ "�New Service 200 Amps Volts Overhead 0 Undgrd ■ No.of Meter Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New residence. 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 Transformers Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool grnd e ❑ grnd ElNo.of Emergency Lighting Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiating Devices No.of Air Cond. TotaTons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water KW No.of No.of Devices or Equivalent Heaters Signs No.of Data Wiring: Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) 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, f er u that the information on this application is true and complete. FIRM NAME: Neil Schoener �� pp p Licensee: Neil Schoener Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: 13949 Address:44 TRADERS LN,W YARMOUTH MA 026733333 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 signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Signature Telephone No. � PERMIT FEE:$180.00 fur-a,,, cm-,f) V. A,/ (° r(`g 124 ^* 6 21 f019 Few -ruvoH -/'at�c� �vt�iivr r � ) `6 Zoe kr) e t^lL� off/Lff�zrJ JA- e , 5° ee ?// k i • J n/n�'/n L� ��jj CI7Lq'tORQ/t 0 Official Use Only Wit :1. c7 S i _.1_ ' Zepariment 01 giro Services permit No. �=-� 3C 7 � , �in 3 BOARD ' L OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �` i 'ev. ]/07] eave blank �' l��`� f APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 'e�� All work to be performed in accordance with the IO WORK (PL�4SEPRINT�tMassachusetts Electrical Code C),527 Cl�1 Zoo INK OR TYPE ALL INFO . ,� City or Town of: ADT�INFORMATION Date:_ ;� - 3 1_ � C BY this application or the d V10 y To the I 11) im erstgned gives notice of hiserector of k jesc - \\ . Location(Street&Number) • �intention to perform the electrical work escnbed below. LAI ('JOsi Owner or Tenant i'' IPT-WVp yJ � � Owner's Address Telephone o. Is this permit in conjun^ctioli with a ba4ding permit? Yes Purpose of Building !l✓ �J_,•,� UtilityNO ❑ (Check Appropriate Box) Existing Service C� Authorization NO. a .7 (e 413 r Amps Volts Overhead❑. Ua New Service � Amps1 �`�❑ o,of Meters oNs Overhead 0 Undgrd of Feeders and&opacity No,of Meters Location and Nature of Proposed Electrical Work: No.of Recessed Luminaires Co 'lesion o the ollowin- table No.of Cei1.-S be waived: the! . for o Wires. asp.(Paddle)Fans o.of Total No.of Luminaire Outlets Transformers ICVA No.of Hot Tubs No.of Luminaires Generators KVA Swimming Pool Above la- 'o,o Brits cy . ,i�g No.of Receptacle Outlets mod' ❑ d. ❑ gaffe Units No.of Oil Burners No.of Switches No.of Gas Burners FIRE ALARMS No.of Zones "o.of Detection and No.of Ranges Initiating Devices No.of Air Cond. o" No.of Waste Disposers Tons No.of Alerting Devices users eat umber Tons o.of etf-Contai,_, No.of Dishwashers r DetectiodAlertia_ Devices Space/Area Heating KW No.of Dryers Local❑ Municipal Heating Appliances Connection ❑ Ofint • No,of ater KW Security Systems:* Heaters KW No.o o.of No.of Devices or E.uivalent Si- 's Ballasts Data Wiring: No.Hydromassage Bathtubs Na of Devices or E.uivalent No.of Motors Total HP Telecommunications Wiring: OTHER' No.of Devices or E.uivalent '� Estimated Value of Electrical Work ` Attach additional detail' desir to Start (When requiredli as required by the Inspector of Wires. ,,..� by municipal.policy.) WorkSURANCE C eons t. be requested in accordance with MEC Rule l 0,and upon completion. NW RA waiv:. by the owner, the licensee provides proof of liability i ce including ou no.permit for the performance of electrical work may undersigned certifies that such cove .• completed operation"coverage or its sub Y issue unless CHECK ONE: INS : is in force,and has exhibited proof of same to the substantial equivalent The t� INSURANCE ;1 BOND ❑ OTHERpermit issuing office. I cet7ify, under the 0 (Specify-) FIRM NAME: p penalties ofperlur7',that the information)n this ap lication is true,0 Licensee: fir! C>l�.'— and complete. (if licabl Signature LIC.NO.: f°= �g aPP e,en ' t"in the li nse • Address; --��be Lin ) 4-1.- ---tIC.NO.: ..1 "`Per M.G.L. C. s.57-61,security ✓ 6,ze. 7,/ Bus.Tel.No.: �'- j OWNER'S INSU 147,s.S7 , work requires Depa rent of Pub c Safe Alt Tei.No.: • �� required by law. WAIVER: 1 am aware that the Licensee does not havethe liability• Lic.No. Owner/Agent By my signature below,I hereby waive this r tY insurance covers i Sismature requirement I am the(check one []owner ge n ❑owner s a ens