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Home My WebLink AboutBLDE-21-005997 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-21-005997 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:4/16/2021 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. / �✓` `If V_ p Location(Street&Number) --1-;or 'T.� Dol) t 5( (a J WIN,ar—C7-- Owner or Tenant Telephone No. Owner's Address 3 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriatg x) J0 Purpose of Building Utility Authorization No, 5467365 ' U „� l Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters _(�� New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install temporary service. 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- I: 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. Total No.of Alerting Devices Tons 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 Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens 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: Michael R Fagnant Licensee: Michael R Fagnant Signature LIC.NO.: 33609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 11 Regents Gate, Sandwich MA 025632425 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: $50.00 ell 446 (0 -2{ C.omntonwaahh of Mamaciauseth Official Use Only ,.. <11 Apar/men' cc77 �(77 Permit No. '--C�9 7 Apar/men'o`1 im Jowrced • tI w BOARD OF FIRE PREVENTION REGULATIONS Rev 1/07cy and Fee Checked '•.. ) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/- /3 A / City or Town of: yit�Ai o_leil 4 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) 6 ct,j') let- sl/Pei`___ Owner or Tenant Re)4 .T ifd rw[I:ri` Telephone No. re'eS- -///cry2 Owner's Address 5t Str Ili I Iii 11 /lc/ r. s 612 d1...,/.4 Is this permit in conjunction with a building permit? Yes gl No ❑ (Check Appropriate Box) _ Purpose of Building /7. sr C�eA l if re 94 Utility Authorization No. ..S-416 7 3 6 3 Existing Service Amps / Volts Overhead n tindgrd❑ No.of Meters New Service /Ct L' Amps /1 u /2c/c' Volts Overhead® Undgrd ❑ No.of Meters / Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: 7�p i , r'c,czici --cfo-mpletion of the following table may be waived by the Inspector of Wires. Isle.of No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans _Transot ansformers KVAA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Aboveln- No.of-Emergency Lighting No.of Luminaires Swimming Pool grad. ❑ grad. 0 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. Tons No.of AlertingDevices Tons No.of Waste Disposers Heat Pump-Number Tons KW No.of Self-Contained p Totals:_ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ other Connection No.of Dryers Heating Appliances KW Security Systems:* Na of Devices or Equivalent No.of WaterKW 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: "/,-- p 41,/, Se9kvic----C Attach additional detail if desired,or as required hr the Inspector of Wires Estimated Value of Electrical Work: ?GC) (When required by municipal policy.) Work to Start: 4-/i'"".4.1 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 permit issuing office. CHECK ONE: INSURANCE Pa BOND 0 OTHER 0 (Specify:) I certi s,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: /27/ c.L cr,P/ P6._7 11 4147 LIC.NO.: Licensee: S#7,,,1., Signaturrile LIC.NO.: 33-601 6----- Inapplicable.enter 'exenut"in the license ry+mhe line.l Bus.Tel.No.; ,rY Address: f- . CSG 2 �. / _ �'4 L! J 02Z, Alt.Tel.No.: 3(o VJ' r j- "Per M.G.L.c. 147,s. 57- ,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ v . 00