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Home My WebLink AboutBLDE-23-000491 Commonwealth of Official Use Only - E` Massachusetts Permit No. BLDE-23-000491 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:8/1/2022 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) 15 WADSWORTH LN Owner or Tenant Thiago Paraguay Telephone No. Owner's Address 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: Trench&conduit for future service for 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 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. Ton l 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 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent 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 Eapivalent 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 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: $50.00 ' l..ommonweaLth yyj / o`ri/aedachuealfe Official Use Only _,�,. ( cc77 Permit Na3' rt': •partm.nf o`,}l, �ervicee CI 1-11 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked '•,. [Rev. 1/07) ----------- (Icave blank) APPLICATION FOR PERMIT TO PERFORM ELECTCA WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: T �!1 200 City or Town of: YARMOUTH To the Inspector f Wires By this application the undersigned gives notice of hi or h. intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant L— i- Tele one No. 7 l�gc - 47/0 Owner's Address a =�� OIMSP1 4 YAM Is this permit in conjunction with a +adding permit? j Purpose of Building No 0 (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead New Service 0 Undgrd 0 No.of Meters Amps ____�olts Overhead 0 Undg rd -_t___. / (5 Number of Feeders and Ampadty No.of Meters Location and Nature of Proposed Electrical Work: . • , r ( .It �� r D ui kr} t "� Com.letion o the ollowin_• table m be waived b the In U No.of Recessed Luminaires No.of Cell.-Susp. cror o Wires. "! p (Paddle)Fans '0.a ota �t No.of Luminaire Outlets Transformers KyA �k No.of Hot Tubs Generators KVA A No.of Luminaires Swimming PooladVe 0 ln- ad. 0 o.o meirgency g ng No.of Receptacle Outlets ' Batts Units No.of Oil Burners FIRE ALARMS No.of Zones "= No.of Switches No.of Gas Burners o.o t etec on an, I No.of Ranges Initiatin. Devices No.of Air Cond. ota Tons No.of Alerting Devices No.of Waste Disposers 'eat 'amp `um er ons • �' Totals: ""�`"•'_. o.o e outs ne, No.of Dishwashers Detection/Alertin, Devices Space/Area Heating KW Local❑ •un c pa No.of Dryers Heating Appliances KW ecu ty ystemsConnection Other o.o "a er .o.o No.of Devices or E,ulvalent Heaters ' o`o Data Wiring: Si:ns Ballasts No.of Devices or E,uivalent No.Rydromassage Bathtubs No.of Motors Total HP a ecommun ca,ons " r ,gg• OTHER: No.of Devices or E,aliment Estimated Value of Electrical Work: 3h-- Attach additional detail if desired,or as required by the Inspector of Wires. Work to Start: (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCECOVERAGE: 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 penahies of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: LIC.NO.: (ifapplicable.enter"exempt"in the license number line./ Signature LIC.NO.:—_ Address: Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Mt.TeL No.Lic. : OWNER'S INSURANCE WA I am aware that he Licensee does not have the liability insuranceoverage n� required b law. Owner/Agent stoma ,I hereby waive this requirement. I am the(check one II owner's y q / owner Signature �t�v //�► Telephone a:ent. No. PERMIT FEE:$