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Home My WebLink AboutBLDE-17-000585 • Commonwealth of Official Use Only foor Massachusetts Permit No. BLDE-17-000585 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:8/3/2016 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 33 LAKE RD Owner or Tenant INKLEY BRADFORD Telephone No. Owner's Address 33 LAKE ROAD,WEST YARMOUTH, MA 02673 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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel and addition Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 12 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators O O i A No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Eme : 1 h 1 ` grnd. grnd. Battery U 4 l,• .--. No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALA' • : 1. • o No.of Switches 4 No.of Gas Burners No.of Detection an. Oti Initiating Devices i No.of Ranges No.of Air Cond. TotaTonal No.of Alerting Devices � No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Othe . o Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 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:$75.00 4_061( 05/(7 ' .8)1249PPozi - %C66/ CJ �, 7rn'e . awl L.ammorwJZfx of///a,sac cl#a Official Use Only I• _- 1= : `2c c�77 Serviced Permit No. +_ parfinrnt olJirc Jcrviccd �# Say - - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/07] ---- (leave blank) APPLICATION FOR°PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.D0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D ate: e City or Town of: YARMOUTH To the Inspecto of Wi es: By this application the pndersiped gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 33 e k t ) , Owner orTenant eivti s-A.t co Telephone No. 649 o Owner's Address �� `~ ' Is this permit in conjunction with a building permit? Yes _. T c� g F No (Check Appropriate Box) Purpose of BuildingS co � hj' �-c Utility Authorization No, QExisting Service 4 Amps / Volts Overhead Undgrd ❑ No. of Meters New Service ,,(20 Amps / Volts Overhead Undgrd No. of Meters Number of Feeders and Ampacity Location and Nature nof,Proposed Electrical Work: e...://- I �� iiT/� 4 tr^ , 4100- ny /sem- ,.s n _ Completion of thejollowinz table may be waived by the Inspector of-Wires. No.of Recessed Luminaires /2..._ INo. of Cei1.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Luminaire OutletAta... !No.°of Hot Tubs Generators KVA No. of Luminaires Swimg ponl Above ❑ In- ❑ No.us r:mergency Lighting arnd. Qrnd. 'Batters:,Units No. of Receptacle Outlet ` l•—• INo. of Oil Burners - !FIRE ALARMS Na. of Zones No. of Switches G-/ INo,of Gas Burners Na.of Detection and No. of Ranges InttrattnQ Devices Na of Air Cond. ToToutalt No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons IKW Na.[ of Self-Contained Totals: IDetection/4lertinQ Devices No. of Dishwashers ISpace/Area Heating KW• Local❑ Municipal Connection No. of Dryers Heating Appliances , Security Systems:* No. of Water No.of Devices or Equivalent Heaters KW No. of No. of Data Wiring: Signs Ballasts No.of Devices 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: /&j7 ce (When required by municipal policy.) Work to Start:jp7(G //, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: 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 ❑ OTHER 0 (Specify:) I certify, ander the paints and penflhYes of perjury, that the information on this application is true and complete, FIRM NAME: LIC.NO.: Licensee: �_ Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Address: Bus.Tel,No.: J 'PerM.G.L. c. 147,s.57-61,security work requires Department of Public Safety"5"License: Alt.L cI.No. <z— OWNER'S INSURANCE WAIVE•: :.1.7.ware that the Licensee does nor have the liability insurance coverage normally 5 required by law. By .,.'si - , ereby waive this requirement 1 am the(check one)❑ owner o �I Owner/Agent � ❑ wner's agent Signature 7 ? PERMIT FEE: $ tl �� —46: 10elephone No. s/