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Home My WebLink AboutBLDE-21-006523 '.�\ Commonwealth of Official Use Only Al%e ;.�,+ Massachusetts Permit No. BLDE-21-006523 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:5/11/2021 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) 9 EMBASSY LN 37.E'2—? s 8(1 e Z Owner or Tenant VAILLANCOURT CHARLES J Telephone No. Owner's Address VAILLANCOURT SHARON D, 349 PLAIN ST, MILLIS, MA 02054 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install additional lights&receptacles in basement. 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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: $75.00 2,0,y,Q_,,, ,...(,,,(v ff_g_ 1• ,e 5/3„tbytet'61- 8) tA4(t 7/� =iw- (C1W '- /i;l t 6 ('s, 9 •-• -, ,•• (--- I official Use Only t. Corosonorurimati4 4 nkalachumtti c). 7-d,:.-...-•".:S,,,;, , 1 L.7).,04,6nird oil Permit No 5ir....C).1ViCal ' Occupancy and Fee Checked I 1 cf BOARD OF FIRE PREVENTION REGULATIONS Rev. 110-71' (leave blank; c'' - -.) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK _ Q1 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 City or Town of: V,, ,A4RE.MOUTH To the Inspector of Wires: --)-1 By this application the undersigned giv,s notice of his or her intention to perform the electrical work described below. CNO; Location(Street&Number) - Tho (0,- ...)C k..' ' ,;j' ' i Ai 1 c A ---1-ii Owner or Tenant I j") ( ) - . a VI MI Telephone No. \-..! . , .,_ Owner's Address 0,01 i' ,i C.., i le L. , .. , a i.' 02 0 7----) is this permit in conjunction with a bui • 0 g permit? Yes .t? No 0 (Check Appropriate Box) s..../ (-- Purpose of Building. Utility Authorization No. '''.. --.... Existing Service 100 Amps / Volts Overhead D Undgrd 0 No.of Meters ----. ' 7--- New Service Amps I Volts Overhead 0 Undgrd CI No.of Meters -----e ••.,..) Number of Feeders and Ampacity c ,,,.:....) Location and Nature of Proposed Electrical Work: j,n9--aA add i ticy)6..4 , vvt- at -(. Es u' & >tui kyt&initt1-1- ai---61 Prrik-X-0.,<AA Lie. \41, nuipoil— Completion o f the fglikwinVable mat be waived hr the In our of Wires. No..of otal No.of Recessed Luminaires No.of co...Sitsp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA o film No.of Luminaires 1 Swimming Pool Ah°ve 0 grnd.in- 0 ZaiteorEmer genqAA g g &rod. 7 Units No.of Receptacle Outlets V No.of Oil Burners FIRE ALARMS No.of Zones , No.of Switches 2. No.of Gas Burners No.of Detection and Devices 1 1 Total No.of Ranges No.of Air Cond. No.of Alerting Devices Tons Heat Pump Number Tons I KW fNo.of Self-Contained No.of Waste Disposers Totals: Detection/Alertingpevices No.of Dishwashers Space/Area Heating KW "cal D P:anntigla 0 °ther No.of Dryers Heating Appliances KW Security gystems:t No.of Devices or Equivalent No.of Water No.of No.of KW Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Wiring: No.Flydrom Teleeommunicationsassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach odditional detail if desired.or as required by the Inspector of Wires Estimated Value of Electrical Work: 1 O . 0 00/ (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 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: _ LIC.NO.: Licensee: Signature LIC.NO.: lfopplicabk,enter-"exempt"in the license number line./ Bus.Tel.No.: Address: Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic. No. OWNER'S INS ' ANCE WAIV ' • 1 am aware that the Licensee does not hove the liability insurance coverage no ....` required by lagla4\t my signa her by waive this requirement lam the(check one)0 owner 0 own, s agpt, A , Owner/Agent Signature .. , : . . Telephone No 500484101PERMIT FEE: $ /1 S 1 \ \ \\X\\ \\\,\, (...,.. 1--, .,..... ... k:/:- ..i :,>.,,,,,,,:, p, ',,,,./1::,:-,-,'E:'1 ' A- -----,;-,1 r IN:kr"- - --kft ,?•:;,. • ' 4 4\ - ,-,,,,v - p ', ...'''V,,,,,,:' \ .,. q ' ',' 1, ' ,,,,, „,__ , ',,,-. ' . c,,, \ .,. 4 ` '3 ' tom'^ ^' '^.,., \ ° E p _ , iI ., _ SP �; - { ry. 3 E., " .„1 , EBB \\\\ t v. �f'�j � »vc 'M _ -\--)'„-t i *., _.. _. \\\\\\\ \ i \ .\\.\\\\\\\\\,,\\ \\,..,:s\ O)lHO... -AS „_ _ ..,M,,,., 60d SNOLLV1f#dWOD 31VO d0 ON i33HS dnaaaans