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Home My WebLink AboutBLDE-21-003650 •A Commonwealth of Official Use Only filltbi Massachusetts Permit No. BLDE-21-003650 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:1/4/2021 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) 39 MILL POND RD Owner or Tenant Gloria Needham Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check lOpel*Box) Purpose of Building Utility Authorization No. °i t; Existing Service 100 Amps "` P Volts Overhead ❑ Undgrd ❑ ers 4• New Service 100 Amps Volts Overhead CIUndgrd (4r Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Service upgrade. ic- 1/.. )).--P- P 40' & Completion of the following table ma of--1 p}6 i ells ector Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers VA 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent KW 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: 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: Lloyd R Smith Licensee: Lloyd R Smith Signature LIC.NO.: 15688 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 1ST ST, MELROSE MA 021764010 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 602-C-4ficir _Ci3s 341.2,e ammonweal h �y/ I. «- r °`r i/amacsffa Official Use Only c `� 2epartinenE Permit No. li ol.tire service! BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked " a [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYP ALL INFORMA,T Date: (MEC),527 MR 12. N) B City or Town of: _A i IV) {\ - -� y this application the undersigned es notice of his or her intention to To the Inspector of fires: Location(Street&Number) 1 M` I� 6 ( the electric work described below. Owner or Tenant C; 1 ( t i t' L'' t Owner's Address 9 Telephone No. ; 1�, Is this permit in conjunctio with a building permit? Yes ❑ No �-7, Purpose of Building (.1��C 9 1 4 �1 (Check Appropriate Box) Utility Authorization No. '4L SSA-1 i i Existing Service i L.i� Amps 17 f" 1 4 olts Overhe Undgrd❑ 1 No.of Meters New Service I L(j Amps I" /2`--( olts Overhead Number of Feeders and Ampacity Undgrd❑ No.of Meters Location and Nature of Proposed Electrical Work: ,`=Ask .%^ C Completion o the ollowin! table ma be waived# the Ins.•ctor o Wires. No.of Recessed Luminaires No.of Ceil.-Sus . `o.o p (Paddle)Fans Transformers ota No.of Luminaire Outlets KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pant 'ove ❑ n- 'o.o Units mergency ig, ; ,g t' d. d. Bane Units 2 No.of Receptacle Outlets No.of Oil Burners ., FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners `o•o 'etection an ( No.of Ranges Initiatin Devices No.of Air Cond. o Tons No.of Alerting Devices No.of Waste Disposers eat'ump `um 1 er. ons T `o.o e ontatn Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local 'umcipa ❑ Connection ❑ other No.of Dryers Heating Appliances scanty stems: KW o.o ater KW .o.o `o.o No.of Devices or E#uivalent _ Heaters Sins Ballasts Data Wiring: ( No.Hydromassage Bathtubs No.of Motors No.of Devices or 1 uivalent Total HP a ecommumcahons "uing: rir '� OTHER: No.of Devices or E i uivalent .....c /� Estimated Value of Electrical Work: 2 �`�ill c`�"7 Attach additional detail if desired,or as required by the Inspector of Wires. :J Work to Start: Inspections (When required by municipal policy.) e, i, INSURANCE COVERA E: Unless waived aived by the owner no permit uested in ar ccordance orm Rule el and upon completion. the licensee provides proof of liabilityinsurance including"completed operation" of electrical work may issueunless undersigned certifies that such coverage is in force,and has exhibited proofof same coverage perm t substantial office.equivalent. The "> CHECK ONE: INSURANCE ,�-, I certifr,CK undeONE: t L sOND 0 OTHER ❑ (Specify:) pains and penalties o perjury,that the info FIRM NAME; rntation on this application is true and complete. C. ....C.... LIC.NO.: Licensee: - �' 1 Signature _� n (If applicable,enter"exempt"in t e license number line.) LIC NO.: 1 I.l Address: ' Ib1 Li 1 `�j t c j► S j l 1 << Bus.Tel.No: s 1 )c.�. Per M.G.L.c. 147,s 57-61,security work requires �� .r} ��c Safety"�, h Alt.TeL No.: ` OWNER'S INSURANCE WAIVER: I am aware that theeLLicensee dont of es not have the liability Lin.No. required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner ty insurance coverage normally Owner/Agent0 owner's a ent. Signature Telephone No. PERMIT FEE:$ f k"� E .... :...f