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Home My WebLink AboutBLDE-22-006649 .s. Commonwealth of Official Use Only * fi-lit% Massachusetts Permit No. BLDE-22-006649 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:5/18/2022 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) 22 TERN RD Owner or Tenant Glenroy Burke Telephone No. Owner's Address 22 TERN RD, SOUTH YARMOUTH, MA 02664-2051 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: Correct owners workmanship. (Per attached) 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 Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine 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 Equivalent 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 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: DAVID R NICOLL Licensee: David R Nicoll Signature LIC.NO.: 37557 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 144 DRIFTWOOD LN, S YARMOUTH MA 026641038 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. P RMIT FEE:$75.00 Nam. 64/Aneti 6.( \,j 1.1,‘(,,.ii,g, • dol?, 71L w/i. lt60 934tom u/A0 [ / fi�/ Official Use Only tG + v-r _ Permit No. L (o Wl ryc�� r C 'fit �2)partm.ent of-tire Jeraice.t 'f' v BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked .+ [Rev. 11071 (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),,527CMR 12.00 (PLEASE PRINT IN INK OR TYP LL INFORMATION) Date: „N y � 0- 4-- City or Town of: Ak` v" 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) a �/T(tiiJ iL ` Owner or Tenant t .NI ` R KC Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service "-D-'3 Amps /'3-1' / `'t4'"Volts Overhead ffr Undgrd ❑ 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: 5��= Drat-r� j, Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ID Battery of Emergency Lighting grad, grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Detection and No.of Switches No. of Gas Burners Initiating Devices No. of Ranges No.of Air Cond. Total 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 ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW 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: 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the .ermit issuing office. CHECK ONE: INSURANCE L4 BOND 0 OTHER 0 sect :) I certify, under the ins and penalties of perjury, that the informatio on this gpplic• ion i ue and cgmplete. FIRM NAME: l vt N�Co ►.t_. / j LIC.NO.: -3-7 C51 E Licensee: Signat re 0, LIC.NO.: (If applicable, enter "exempt"in the license lumber line.) Bus.Tel.No.: SC' 394 -(0131 Address: I4 Li bit1 FTtN00.4 UI S.YM VAirk t trVIk- +3L121 Alt.Tel.No.: 6-0FS-30'"131,3(rt.U *Per M.G.L. c. 147,s 57-61,security work requires Department of Public Safety "S"License: Lic.No. 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) 0 owner 0 owner's agent. Owner/Agent �( - _ _ Si mature `-0 h t c 5 C C.'`n `"j eie hone No , PERMIT FEE: .S I tia,(1?)1 c2,10 c Ni r)(Y) c Oo/ 2-cf\ Q z(r.19/ f7r, ' 2Jv W ? 0s4V1ft1 ( -029 /AYZLS afeT -50c:9\/ - - ' 0:02.,2 0 _11 -( )v` ��v M s 11 -5 /16) _3N'v q5-Y) Ni -(-1) c1-1-1911 rl i!on X .. � 174 jJ i ),L) 11 a ?_L ><1-41 i,,,