The URL can be used to link to this page

Home My WebLink AboutBLDE-22-004576 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-004576 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:2/17/2022 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) 180 OLD MAIN ST Owner or Tenant Brian Grimm Telephone No. Owner's Address 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: Replace fixtures per attached. 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Sims 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: TYLER W PAYNE Licensee: Tyler W Payne Signature LIC.NO.: 22091 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:5 JANS PATH, HARWICH MA 026452458 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 my 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: $50.00 e(2A-e(-22eg iii. Commonwealrn un ptaoDauit........ 2_t�S� I r Permit No.C � �'�' _�� Department of Fire Services Occupancy and Fee Checked �� ;' BOARD OF FIRE PREVENTION REGULATIONS (Rev.9/05( Heave blank) APPLICATION FOR PERMIT TO PERFORMELECTRcCA o alAll work to be performed in accordance with the Massachusetts Electricalcodc n C ) I a� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: %rr x To the Inspector of f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. y Location(Street&N tuber) i FO Id Ma.to Telephone N. 77`1 Owner or Tenant ►'1 -t `\ Owner's Address _% 4,1 n ate It( M A 6. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building( (1 1' Utility Authorization No. Existing Servic c_ .% Am s 7 I Volts Overhead[ Undgrd❑ No.of Meters — New vice Amps I Volts Overhead No.of Meters Undgrd .--.— Number of Feeders and Ampacity /' ��__ lit S'�c��/ Location and N re of Proposed Electrical Work: C.") I ri uucy-G- E ' (mu I'v -- x l 00s I ) VI r\C) )` .)t'Y1J is IAJ Jc f be d raxm `t-Z i 4'Ss" Completion of the following table may be waived by the Inspector of Wires. go.of Total No.of Recessed Luminaires No,of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In. No.or Emergency Lighting No.of Luminaires Swimming Pool grnd. grnd. Battery Units ._ No.of Oil Burners FIRE ALARMS No.of Zones No.of Receptacle Outlets o.♦ etect on an No.of Switches No.of Gas Burners Initiatig Devices ota No.of Alerting Devices No.of Ranges No.of Air Cond. Tons eat ump um er ons o.o e • onto ne No.of Waste Disposers Totals: Detection/Alertin Devices Local❑ 0 Other Space/Area Heating KW Conneunicction _____ No.of Dishwashers p 'Local Sys{ems:* Heating Appliances KW No.of Devices or Equivalent No.of Dryers o. No.of Data Wiring; o ater KW o.of Ballasts No.of Devices or E uivalent Heaters Si ns a ecomn,umcations >irm�: No.Hydromassage Bathtubs No.of Motors Total HP No.ofDevicesunicati or Equivalent : OTHER: Attach additional detail if desired,or as required by the Inspector o f Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 15 Inspections to be requested in accordance with MEC'Rule 10,and upon completion. INSURANCE CO RAGE: Unless waived by the owner, permit for the `colmance of ve age or its substantial equivalent.ctrical work may The unlessthe lioanscc provides proof of liability insurance including undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ►`! BOND ❑ OTHER 0 (Specify:) I certify,under the ains and penalties of�.E.CT,perjury,that the information on this application is true and complete.: FIRM NAME: LIE.NO: OZ. � Signature �.�• Licensee: Ty ___ W• — ,^ Bus.Tel.No.• i'� i Ei� [�^tom-* (lf able enter"exempt," in the license number line Alt.TeL No.: Address: ere: *Security System Contractor License required for it�thatothc;l'icenslee does not have the liabilitybnseru once coverage a11ent. y OWNER'S INSURANCE WAIVER: I am aware owner ■ owner's required by law. By my signature below,I hereby waive this requirement. I am the(check P�PERMIT FEE: $ 9 Owner/Agent Telephone No. Signature