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Home My WebLink AboutBLDE-22-006360 Commonwealth of Official Use Only it � •, Massachusetts Permit No. BLDE-22-006360 • 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:5/3/2022 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) 140 BAXTER AVE Owner or Tenant BROWN NELSON W Telephone No. Owner's Address BROWN ELIZABETH H, 140 BAXTER AVE, WEST YARMOUTH, MA 02673 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: Disconnect off peak water heater meter. 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. 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 ❑ 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ROBERT F THIBEAULT Licensee: Robert F Thibeault Signature LIC.NO.: 22475 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 36 GOVENOR BRADFORD RD, BREWSTER MA 026312806 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 9/yv ' U15 Qm dai wticd -Z.2ii RV n7 14 Commonwealth o`Maddachudstki Official Usc Only ;3.i=•1f' cc/�� nn Serviced Permit No. _.rJvi Jisparfmsni o/.. ire Serviced ,-i,I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev.OccuI/07] (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: i /-i/Z z 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) /Lf C7 /9,4 .-in- 4 '& Owner or Tenant A.' Z Sc.-) j}' ,[,uer) Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utili Authorization No. /',E • Zi.g C Existing Service 2oc' Amps (2C'/2 Volts Overhead gir Undgrd❑ No.of Meters 3 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity /_ Z c,c. Location and Nature of Proposed Electrical Work: p e QC,�r, C C �� t'�� tf � S is: Completion of the followingtable m be waived by the Ins Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sasp.(Paddle)Faos No.of- Total `.° Transformers KVA C..1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA ram, st No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. 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. 7 otal Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number'Tons 1 I KW No.of Self-Contained Totals: Detection/Alerting_Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connect No.of Dryers Heating Appliances Kam, Security Syst ms:*on No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: 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 permit issuing office. CHECK ONE: INSURANCE [`} BOND 0 OTHER ❑ (Specify:)c.cm,at(9e--e e 9/ZZ(ZL I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: �� LIC.NO.: Licensee: �jG�/Q ��r.�Lc��-- 53gnatur ��,�� LIC.NO.:EZ'2 y-7.� (If applicable,enter"exempt"in the licens number line.) 4 6-Cr.., ;3,2 -Pxe2b ! -> tZ ' C;Y14. Bus.Tel.No.: 2 3�-1 3 Address: Z 2 — eS Ti( O i' 3, g Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.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,1 hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. l PERMIT FEE:$