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Home My WebLink AboutBLDE-22-000238 #11 or ►, Commonwealth of Official Use Only ��, Massachusetts Permit No. BLDE-22-000238 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:7/14/2021 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) 11 SW NEW HAMPSHIRE AVE Owner or Tenant Paul Cruz 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install smoke/CO detector,,x r 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 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 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices 1 No.of Dishwashers Space/Area Heating KW Municipal Local 0 Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent KW No.of No.of Ballasts Data Wiring: Heaters Siens 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: William H Nelson Licensee: William H Nelson Signature LIC.NO.: 26513 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:871 BUMPS RIVER RD, CENTERVILLE MA 026323321 *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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERI MIT FEE:$50.00 CCe 7cf2 RECEIVED p� /�j� �// L - II Commonwealth o//r/aMachaJeh Official Use Only lili , aG JePartmerct ol ire�ervice4 Permit No. �— l/2 �-�/'V JU= �� _ --s' • �_ rMEBOARD OF FIRE PREVENTION REGULATIONS [ReOv 1 oancy and Fee Checked BUILDING ►a'' NT By: (leave blank) APP -I ATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYP ALL INFO TION) Date: V�f 7/ �` City or Town of: e irTo y ! es: By this application the undersi To the Inspector of Wires: gn gives n tice of h' or her inten on to perform the electrical work described below Location(Street&Number) // ✓ -� /� Owner or Tenant Paz,/ Cr7. L, fl. Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [1 No (CheckV Appropriate ppropriate Box) Purpose of Building ,OcaL/(,-1>,, Utility Authorization No. Existing Service Amps / Volts Overhead I I Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead I I 17 Undgrd g I I No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _2'n ‘,,// �� 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 iNo.of Zones ,1 No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 3 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: i Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* Ali No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent A 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: Inspections 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 cii undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) n I certify,under the pains andpenalties of perjury,that the information on this application is true and complete. ¢q FIRM NAM • Licensee: ,(� - _ LIC.NO.: � �n f, Signatur ., . >� LIC.NO.:, 7J "fL. (If applicable,enter "ezo in the license nu b line J Address: Z��- 4/ t /11/� G as Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No.. ---7 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 one ❑owner ❑owner's a.ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ IT