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Home My WebLink AboutBLDE-21-004409 Commonwealth of Official Use Only 0 Massachusetts Permit No. BLDE-21-004409 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) City or Town of: YARMOUTH DaTo the te: 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) 130 CROWELL RD Owner or Tenant TEXEIRA JOSEPH P Owner's Address TEXEIRA PATRICIA, 301 WILLOWGATE RISE, HOLLISTON, MA 01746 Telephone No. Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Apta e Box)3 Purpose of Building Existing Service Amps Utility Authorization No. P Volts Overhead 0 Undgrd 0 �� New Service Amps Volts Overhead ❑ g 7417:5 of Q v Number of Feeders and Ampacity Undgrd 0 � �i7�Location and Nature of Proposed Electrical Work: Low voltage A/V wiring. •ir ! " Completion of the following table may be waived by h 'tom.: ; , Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers t No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming Pool Above d. ❑ grnd ❑ No.of Emergency Lighting rn 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 No.of Ranges Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local ❑ Municipal 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water K� No.of No.of Devices or Equivalent Heaters Signs No.of Data Wiring: Ballasts No.of Devices or Equivalent 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: 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 I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line) Address: Bus.Tel.No.: *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 signature below,I hereby waive this requirement.I am the(check one Owner/Agent ) 0 owner 0 owner's agent. Signature Telephone No. 'PERMIT FEE: $45.00 I A02. 6/Z3 e ' Cormonwaa Mj / r//asaarhuaslta Official Use Only . i 26par#meni o/..tips Serviced Permit No. ``t�� •k' BOARD OF FIRE PREVErNTIQN REGULATIONSOccupancy and Fee Checked 0 Rcv. I J07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE INFORMATI N) Date: City or Town of: ay- By this application the undersigned giv a notice of his o her intention to To the Inspecto of Wires: Location(Street Si Number) � e electrical work desc ' below. Owner or Tenant t V)` E t l Telephone Owner's Address Is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box) Purpose of Building Utility Authorization No. ,_l Existing Service Amps / Volts Overheadt Undgrd❑ No.of Meters w c Amps / Volts Overhead 0 Undgrd( , Number of Feeders and Ampacity g 0 No.of Meters Location and Nature of Proposed Electrical Work: Mill Min VI ' Com.letion o the ollowin m table . be No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans o,o waived b th Ins. iota or o Wires. Transformers No,of Luminaire Outlets No.of Hot Tubs KVA No.of Luminaires AveGenerators KVA Swimming Pool n- '0.o mergency g ng No.of Receptacle Outlets rnd. ❑ u rnd. ❑ Batte Units No.of Oil Burners FIRE ALARMS No.of Zones -''� No.of Switches No.of Gas Burners `o.o etec on an t<a No.of Ranges Initiatin. Devices No.of Air Cond. ota Tons No.of Alerting Devices eat 'ump 'um .r., ons Totals: •• o.o e out; n No.of Waste Disposers ' " Detection/Alerti Devices No.of Dishwashers Space/Area Heating KW "cal 0 `un p Other No.of Dryers Heating Appliances cu Connection 0 `o.o "ater KW tY ystems: Heaters KW `o.o 0 o No.of Devices or E,uivalent Si ns Ballasts Data Wiring: No.of Devices or ,uivalent No.Hydromassage Bathtubs Total HP No.of Motors e ecommu ca r ons s► • OTHER: No.of Devices or ',alive-lent Estimated Value of Electrical Work: Attach additional detail ifdesired,or as required by the Inspector of Wires. Work tot Start: (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE; Unless waived by the owner,no the licensee provides proof E liability insurance including Opermit for the performance of electrical work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the `completed operation coverage or its substantial equivalent. The CHECK ONE: INSURANCE 51 BONDpermit issuing office. lcertijy,under th ins and n 0 OTHER 0 (Specify:) FIRM NAME: 5 pe ties of pe • ty,that the information on is application is t e- aL'� Licensee: Vlr `S w �`tr 'u'DIC.NOplete (If applicable,enter"exempt"in the li erase umber li signature V Address: 1 LIC.NO.: h f , e,2.0 Bus.Tel.No.: �.,sr yj=t 3c/ *Per M.G.L.c. 147,s.57-61,security work requi s Department ic OWNER'S INSURANCE WAIVER: I am aware that Lensee does Safetyot have the liability insurance coverage required by law. By "S"License: Lic.No. .,� Owner/Agent g norms a ly signature w,I hereby waive this requir mane. I am the(check one / owner (♦ owner's a:ent. Signature Telepho PERMIT FEE:$ Btu, 4M (M