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Home My WebLink AboutBLDE-21-006704 �• Commonwealth of Official Use Only L_ I Massachusetts Permit No. BLDE-21-006704 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•5/19/2021 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. Location(Street&Number) 32 CARRIAGE LN 57%F r 7 l -S10 Owner or Tenant CROSBY RICHARD Telephone No. �C7 Owner's Address CROSBY SUSAN H, PO BOX 58,YARMOUTH PORT, MA 02675-0368 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 ❑ 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: In-ground pool. 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No No.of Devices or Equivalent HeatersWater 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: 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:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Brad J Campbell Licensee: Brad J Campbell Signature LIC.NO.: 35550 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:347 TURTLEBACK RD, MARSTONS MLS MA 026481128 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: $85.00 gt-i-C12.1 (C 4 ti 16, c — etywoor aw7V (& , Cvi'4parb lo/ Y. ()p 0CAoruDi0- � O/Z1i �� ("Øi Pjl,� 71% I M `/ --n4Cat- ; f "7(� �,�t�+`fbI►I'l) -i7�sr�ro�as�� A-3 . ah , Co once. '7 j�ac�� Official Use Only ��o c-� cc77n a+ n �spartnunE o�.}i,+s Jirvrese Permit No._ t— l ' ,. If �_. OARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked L p_ w__�.._. [Rev. 1/07] (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: ^ /7, .2 City or Town of: YARMOUTH _ To the Inspector of Wires: By this application the undersigned gives nice-of a of his or her intention to perform the electrical work described below. Location(Street&Number) 2 eq r-r/ Z Owner or Tenant Owner's Address /t'1 Telephone No. Is this permit in conjunction with',building permit? Yes Purpose of Building wec 0 (Check Appropriate Box) UtilityN Authorization No. Existing Service l ay Amps / /2 6Volts Overhead 0 Undgrd� No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampadty 0 Undgrd❑ No.of Meters _ Location and Nature of Proposed Electrical Work: f n ►'d ult. fiJ1 6lZ w C oc, m. ' Com letion o the ollowi table m be waived b the I ctor o Wires. L/ No.of Recessed Luminas No.of Ceil.-Soap.(Paddle)Fanso.o ota CA No.of Luminaire OutletsTransformers KVA Hot Tubs Generators KVA No.of k No.of Luminaires Swimming Pool ve n- o.o mergency g n � No.of rnd' ❑ d• ❑ Bane Units g Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etec on an 1 ° No.of Ranges Initiatin Devices No.of Air Cond. Tana No.of Alerting Devices No.of Waste Disposers 'eat ump `nm er ons Totals: ...._._._...: .._. . °o.o e on net No.of Dishwashers - Detection/Alertin Devices Space/Area Heating KW Local 0 'un No.of Dryers Heating Appliances , ecu ty Cyms.°n 0 Off' o.o No.of Devices orEquivalent o.o Heaters �' S as Ballasts Data Wiring: No.Hydro massage Bathtubs No,of Devices or E nivalent No.of Motors Total HP a ecommun a ons g OTHER: No.of Devices or uivaleat Estimated Value of Electrical Work: ��G' -` —Attach additional detail If desired,or as required by the Inspector of Wires. to Start: — ' (When required by municipal l "2 / Inspections to be policy.) WorkINSURANCE OVERAGE: _Inspections waiveds byto the requested o ermit accordance with MEC Rule 10,and upon completion. the licensee provides proof of liability insurance including"completed operation"e tcoverage or tsormance of esubstantialtrical requivalent The unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE P"BOND ❑ OTHER I certify,under the ins penalties o ❑ (Specify:) FIRM NAME: f ry,that the formation on this application is true and camp/ete tci et`u Licensee: `c t LIC.NO.:'S'j`�•'d _�o Signature (Ifapplicable,enter exempt to the l e LIC.NO.: Address: 7 C/i, line.) *Per M.G.L.c. 147,s.57-61,security work requires De r �/ Bus.TeL No.: G� G O/may OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance covers ej ic Safety"S"License: Lic.No. required by law. By my signature below,I hereby waive this i Owner/Agent requirement. I am the(check one • owner g ors e Signature ■ owner's a.nt. Telephone No. PERMIT FEE:$