HomeMy WebLinkAboutBLDE-21-006844 of a y��(,� Commonwealth of Official Use Only
Permit No. BLDE-21-006844
�, j�.4 ) Massachusetts
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/071
APPLICATION FOR PERMIT TOPERFO ARM ical oELECTRICde (MEC),527 CMRIAL 2.00 WORK
All work to be performed in accordance with Massachusetts
21
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D ate:5/25/20 To the Inspector of Wires:
City or Town of: YARMOUTH
By this application the undersigned gives notice ot his or her intention to pertorm the electrical work described below.
.4,00 j.55
Location(Street&Number) 1 MONROE LN Telepho I►_ r-
Owner or Tenant SWANSON ERIC ••
Owner's Address SWANSON ELIZABETH V, 1 MONROE LN,WEST YeAR❑MOUTH NMAo ❑02673 (Chec ro.r' e t
Is this permit in conjunction with a building permit? Utility Authorization No.
Purpose of Building Und rd ❑ No.of
Existing Service Amps Volts Overhead 0 g No.of Met
Volts Overhead 0 Undgrd CINew Service Amps O
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Garage to family room&shed wiring.
Completion of the following table may be waived by the Inspector of Wires.
No.of Total
No.of Ceil.Susp.(Paddle)Fans No.Transformers KVA
No.of Recessed Luminaires KVA
No.of Luminaire Outlets No.of Hot Tubs
Generators
Above ❑ In- ❑ No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. grnd. Battery Units
No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Receptacle Outlets No.of Detection and
No.of Switches No.of Gas Burners Initiative Devices
Total No.of Alerting Devices
No.of Ranges No.of Air Cond. Tons
Heat Pump I Number I Tons I KW No.of Self-Contained
No.of Waste Disposers Totals• Detection/Alertine Devices
Local ❑ Munici al ❑ Other:
Space/Area Heating KW Connection
No.of Dishwashers Systems:*
Heating Appliances KW SecurityNo. Deviste or E uivalent
No.of Dryers Data Wiring:
No.Heaters Si ns Ballasts Water KW
No.of No.of No.of Devices or E uivalent
He Total HP Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Tel of communi or E uivalent
OTHER: Attach additional detail if desired,or as required by the Inspector of Wires.
(When required by municipal policy.)
Estimated Value of Electrical Work:
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
ctrical work may issue unless the licensee
INSURANCE COVERAGE:Unless waived by the owner,no eration'lt for the coverage or lts sub t ntial of eequrvalent The undersigned certifies that such
provides proof of liability insurance including complete p
coverage is in force,and has exhibited proof of same to the per it issuing
❑office. (Specify:)
CHECK ONE:INSURANCE El BOND 0
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
LIC.NO.: 21302
Licensee:F
IRM NAME: Walter W Kelly Signature Bus.Tel.No.:
Walter W Kelly Alt.Tel.No.:
A applicable,enter"exempt"in the license number line.)
Address:7 MONROE LN,WEST YARMOUTH
uiresnDeO26732731 artment of Public Safety"S"License:
q p
*Per M.G.L.c.N 147,s.57-61,securityagent.
OWNER'S INSURAN CE WAIVER:I am aware that the License does not have❑theo�lp r�� insurance0 wner's ag coverage normally required by law.But
signature below,I hereby waive this requirement.I am the(check one) PERMIT FEE: $75.00
Owner/Agent Telephone No.
Signature
dcAil
NIP .
Commanar.aigi Official Use On1Y
U ,• L� ' 2spartneent of gips Smviced �d Fee checked
_ OccupanCY
C► re
01 BOARD OF FIRE PREVENTION REGULATIONS v. U07j leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
�eY �ll w C to be perf nee in accordance with the Massachusetts �t�.��CMR .00
vC Dste: ��/
(PLEASE PRINT IN INK OR7/li?
ALL INFORMATION) To the Inspector of Wires:
City or Town of: l1 l6 Ul l ' the epe for work described below.
By this application the undersignes notice'offhis or her intention to perform
'y� Location(Street&Number) t?/ `�' �" Telephone No. "�'Yi17
C. Swr�,NL0N
Owner or Tenant
Owner's Address Yes [ No 0 (Check Appropriate Box)
Is this permit in conjunction with building permit? Utility Authorization No.
Purpose of Building No.of Meters
'�cY
/ Volts Overhead❑ Uadgrd❑
� Ezlsting Sendee Amps Undgrd 0No,of Meters
+ l Amps / Volts Overhead
Number of Feeders and Ampacity /Z d(41
3 Electrical Work: _ C(e,'2 ?a /4�41.L,-1
Location sad^�N-�atare of Proposed \
l l I N t No.of Recessed Laminalrce C,• .Ietion' the ll, ' : table be waived, the I,,_ , o Wires.
No.of Cell-S+vsp.(Paddle)Fans
4e Transformers KVA
No.of Luminaire Outlets No.of Hot Tabs Generators KVA
Swimming , ,� n- 'o.o mer
• No.of Luminaires
Pool ,' , 0 `, d.. 0 Bette Unitsgeacy
No.of Oil Burners FIRE ALARMS No.of Zones
.1 No.of Receptacle Outlets •o,o p _ , ,I)a
:`. No.of Switches
No.of Gas Burners IDevices
o• No.of Alerting.Devices
1.
No.of Ranges No.of Air Cond. Tons
.eat , mp `^rim -r ons, °•ffigillil .on! on.
No.of Waste D Totals: ❑ un^'�''� 0 other
, Devices
No.of Dishwashers Space/Area Heating KW Local Connection
.
Heating Appliancesyy
KW No.of Mviees or ent
No.of Dryers'a.a " KW `o.o Data Wiring:
o' Ballasts No.of Devices or , a,t
.Heaters S._ i;
No,Hydromassage Bathtubs
No.of Motors Total HP No.of Devices or ` . . .t
OTHER:
Attach additional detail if desired or as required by the Inspector of Wires.
(When required by municipal policy.)
Estimated Value of Electrical Work:Work to Start: Inspections to be requested inaccordance for the ,and u work may issue unless with MEC Rule 10 performance of upon pon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit operation"coverage or substantial equivalent. The
the licensee provides proof of liability insurance including"completed undersignedto the permit issuing office.
CHECK
certifies that such coverage is in force,and has exhibited proof
K ONE: INSURANCE OTHER ❑ (Specify:)
— BOND ❑ the Inform:don on dtis u is true and coxtl � �AG
I eat*,nutlet th and penalties of perjury _ 1C ''� LIC.NO.: ._._
t LIC.NO.: /'
FIRM NAME: S tore b���
Licensee: Bus.Tel.No:
(If applicable,enter"exempt" a lick a^ui"ber line.) t Alt.Teo Na.:
Address; Department o Public Safety"S"License: Lic.No. _---
work requiresinsurance coverage normally
*Per M.G.L.'Sc. U s.5C 61,securityIII :lent.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee I am the the
liability� III owner �J
required by law. By my signature below,I hereby waive this rein
PERMIT FEE:$
Owner/Agent Telephone No.
Signature