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Home My WebLink AboutBLDE-22-003362 V 1 D Commonwealth of flEOfficial Use Only � Massachusetts Permit No. BLDE-22-003362 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) City or Town of: YARMOUTH Date:To the 1 Inspect or of Wires: 021 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 74 LAKEFIELD RD Owner or Tenant MACARTHUR PATRICIA A TR Telephone No. Owner's Address THE PATRICIA A MACARTHUR LVG TRUST, 74 LAKEFIELD RD, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Existing Service Am s Utility Authorization No. P Volts Overhead 0 Undgrd 0 No.of Meters New Service 100 Amps Volts Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Upgrade panel&grounding. Install generator receptacle&interlock. 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 KVA Generators KVA No.of Luminaires SwimmingPool Above grnd. ❑ grnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets 1 Battery Units No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiatine Devices No.of Air Cond. Total No.of Alerting Devices Ti No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: No.of Dryers HeatingAppliances Connection pp KW Security Systems:* No.of Water KW No.of No.of Devices or Eauivalent Heaters No No.of Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or Eauivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Eouivalent 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 ❑ OTHER I certify,under the pains and penalties of perjury, er ury,that the information on on this application is true and complete. FIRM NAME: JEFFREY T FOSS pp p Licensee: Jeffrey T Foss Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: 36938 Address:33 SULLIVAN RD, W YARMOUTH MA 026733543 Bus.Tel.No.: 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 bylaw.But signature below,I hereby waive this requirement.I am the(check one) CI owner 0 owner's agent. my Signature Telephone No. ��,+�,�Q `Z � PERMIT FEE:$50.00 1/7 ( IBC 0nd RECEIVED 4 I ,I r-r, 4 e' 1 S Comno nwQanh el�"- ' yyii, aaaac Official Use Only 1a — -'C1sinsnf o��i++s Jervicse Permit No. ( -33�� *° ' 4,ot BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/071 leave blank ----- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be rformed pe in accordance with the Massachusetts Electrical Code(M 527 MR 12. WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) � Date: �'� �City or Town of: YARMOUT By this application the undersigned gives noticNIIIIe of Hention to To the Inspector of Wires: Location(Street&Number) i the electrical work described below. Owner or Tenant S Owner's Address Telephone No. S ' sa/� Is this permit in conjunction with a building � ( ^ 8 permit. v \ Purpose of Building Yes No (Check Appropriate Box) Existing Service fl 6 Amps Utility Authorization No. P /J Volts Overhead Und rd N w rvice Amps / g 0 No.of Meters Number of Feeders and Ampad Volts Overhead❑ Undgrd ❑ No.of Meters ____ a` Location `1 /attire of�prop�sedElectrical Work: 1r,% �P. /, �' �� f ko ``. i r, W"�` 'mac' t'i S�% �t �� t��fc/�P� Completion o the ollowin; t m, d � �1�� lb cyr No.of Recessed Luminaires No.of Cell.-Susva o.o be waived b the I .ector o Wires. No,of Luminalre Outlets P (Paddle)Fans o a No.of Hot Tubs Transformers KVA No.of Luminaires Generators KVA Swimming Pool ode ❑ n d• ❑ 'o.o mergency g n Batte Units No.of Receptacle Outlets No. g 'I: of Oil Burners No.of Switches No.of Gas Burners `o.o t . No.of Zones t I I No.of Ranges ec+on an, No.of Air Cond. eta Inftiatin' Devices No.of Waste Disposers Tons No,of Alerting Devices `eat 'ump `um l er ors + , Totals: _...._.__._..... .......__.. ...._. et o e out n No.of Dishwashers Detection/Alertin, Devices Space/Area Heating KW 'un No.of Dryers Heating Appliances Local 0 C KW u ty ystems: tems:lon ❑ 'o.o "a er KW '°•o `o.o Heaters No.of Devices or E,uivalent S ns Ballasts Data Wiring: No.Aydromaasage BathtubsNo.of Devices or i uivalent No.of Motors Total HP a eco of ca ors +' gg. OTHER: No.of Devices or E+uivalent Estimated Value of E tri al Work: ---- Attach additional detail if desired,or as required by the Inspector of Wire to Start: pry- (When required by municipal policy.) Work COVE Inspections to be requested in accordance with MEC Rule 10,and upon completion. the licensee INSURANCE CO proof oE:liability ess waived insurance pt e owner,n no pent for the performance of electrical work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the CHECK ONE: IIVSU o�v/efra�ge�oryits�substantial equivalent. The I certilK under the U fRnAs andNCE241BnakkOND ❑',OTHER ❑ (specify* Co / eiteek e.m$_fc . FIRM NAME: lPer�u that the Information on this a is true and complete. Co t Licensee: (If applicable, ter Signature LIC.NO.: Address: "exempt" r(he i en nu �'e�'-�+ "LIC.NO.: i+l�e line.) *Per M.G.L.c. 147,S.57-61,securityworcense: Lic.No. k requires Bus.Tel.No.. Partment of Public Safe Alt.Tel.No.: / mar • � 71 OWNER'Srequired by Jaw. ByI am aware that the Licensee does not have the liability insurance coverage A�" V U Owner/Agent my signature below,I hereby waive this requirement. Signature q rement. lam the(check one ally Telephone No. owner • owner's a:ent. PERMIT FEE:$