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Home My WebLink AboutBLDE-22-000239 #15 Commonwealth of Official Use Only Massachusetts114, Permit No. BLDE- - 22 000239 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rRev.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 Inspec021 toBy this application the undersigned gives notice of his or her intention to perform the electrical work described below r of Wires: Location(Street&Number) 61111,15 NEW HAMPSHIRE AVE Owner or Tenant Paul Cruz Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Existing Service Amps VoltsUtility Authorization No. p Overhead 0 Undgrd 0 gNo.of Meters New Service Amps Volts Overhead 0 Undgrd 0 Number of Feeders and Ampacity gNo.of Meters Location and Nature of Proposed Electrical Work: Install smoke/CO detecto' 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 SwimmingPool Above In- grnd. ❑ grnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets Battery Units No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiating Devices No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump j Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices 1 No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: No.of Dryers Heating Appliances Connection KW Security Systems:* No.of Water , No. No.of Devices or E i agent .ofNo.ofSion No.of Ballasts Data Wiring: No.Heatersydromassage Bathtubs No.of Devices or Equivalent 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 ofperjury,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.) Address:871 BUMPS RIVER RD, CENTERVILLE MA 026323321 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 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 7iictc/r RECEI NKED Commonwealth jj l.om✓nonweaLth of Maooachus Official Use Onl*y-� `Ititc rS��C�� ` c� c7 Permit No. L J U L i - 2 apartment o }ire S'eruicei s; . Occupancy and Fee Checked BUILDING DE a 4.1, "ENT °'OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) By: _ A ' ' ATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ,C)) 5 CMR 12.00 (PLEASE PRINT IN INK OR TYPE LL INFO TION) Date: 7 / `V�/ / D r City or Town of: � To the Inspector of Wires: By this application the undersign gives noti e of his or,hr intention o perform the electrical work d 'bed belo . Location(Street&Number) f j `'/4h lih ry /f& Owner or Tenant g.' U'Z. /"' Te lap one No. Owner's Address Is this permit in conjunction with a building permit? Yes n No n (Check Appropriate Box) Purpose of Building iO4,Z„61jryr" //dj/Y Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd n No.of Meters Number of Feeders and Ampacity Locati and Nature of Proposed Electrical Work: ✓ / / ,dam✓' , +j Completion of the followin: 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- Li No.of Emergency Lighting grad. grad. 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 Tot No.of Ranges No.of Air Cond. Tons 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 HeatingKW Municipal p Local❑ Connection n ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water KW No.of Devices or Equivalent No.of No.of HeatersSigns Ballasts Data No.of Devices or Equivalent ill 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. \ (When required by municipal policy.) Estimated Value of Electrical Work: V) 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 vi 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:) Q I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 1C�//� 1 iS'�G ► f` LIC.NO.: ate Licensee: Signatu� 07 t/ WQ (If applicable,enter" t"in the license u ber m�) LIC.NO.• /� Address: J ��Zl�'� � �� f Bus.Tel.No.:,_ �y *Per M.G.L.c. 147,s.57-61,security work requires Department of Public SafetyS License: Alt.Lic.T •No77 ��J` « 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 the(check Owner/Agent am one)❑owner ❑owner's agent. Signature Telephone No. I PERMIT FEE: $ p f I