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Home My WebLink AboutBLDE-21-006059 Official Use Only ‘ki\el Commonwealth of Massachusetts Permit No. BLDE-21-006059 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:4/21/2021 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) 21 MONROE LN Owner or Tenant Steve Petluck 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 0 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: Basement bathroom Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires 1 No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches 2 No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices 0 Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW LocalConnection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW Siens Ballasts No.of Devices or Equivalent Heaters Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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� attt such coverage is in force,and has exhibited proof of same to the permit issuing office. ect I �-�°' vas( 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: EDWARD M LYNCH LIC.NO.: 35609 Licensee: Edward M Lynch Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 *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 othe liability in er ranee coverage normally required by law.But s signature below,I hereby waive this requirement.I am the(check one) t. Owner/Agent PERMIT FEE: $75.00 Signature Telephone No. 247 6114-0 141---('' Niat..... (2.9zi.7). eek (17,1 re' CAA 64L-1 o 'tom c(I7/2r vi., r Commonwoa&h.o/Vaeeachudsifa � Official Use Only ''i c� [7 Permit No. (. --(03 4 t�.:o.y �spartmmni of giro Jfrvices } 1{ BOARD OF FIRE PREVENTION REGULATIONS cu � " [ROcev.1/07]pancy and Fee Checked(leave blank) APPLICATION FOR PERMIT TO PERFORM EL CTRI AL WORK All work to be performed in accordance with the Massachusetts Electrical ( 527 R 12. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the I ctor o it : By this application the undersigned gives notice of his or her intenti perfo the el ctri ork escribed bele Location(Street&Number) r Owner or Tenant 'leitl: Telephone No. cOwner's Address v 1 7- Is this permit in conjunction th a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 1,76 Ulf/ / Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampadty Location au Nature of Proposed E cal Work: /Pe7'c/ " vi i / Completion of thefollowingtable may be waived by the Inspector of Wires. Total lb, No.of Recessed Lamin.lres / No.of Ce1L-Snsp.(Paddle)Fans Transformers KVA nNo.of Luminaire Outlets No.of Hot Tubs Generators KVA mot- No.of Luminaires Swimmin pool Above in- No.of Emergency Lighting g _and. ❑ t:rnd. ❑ Battery Units �` No.of Receptacle Outlets i� No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Initiating Devices 1 t•; No.of Ranges No.of Air Cond. Total No.of AlertingDevices _ Tons Na of Waste Disposers Totals: Pump Number.Tons •,KW 'No.of Self-Contained Totals:_ Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local 0MuniciConnectionpal 0 Other No.of Dryers Heating Appliances KW Security Systems:* 1 _ No.of Devices or Equivalent No.of Water 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 9 E 'caT Work: (When required by municipal policy.) Work to Start: i " Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO E: 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 !1 BOND 0 OTHER 0 (Specify:) I certify,under the pains and, naldes of pedury,that the information on this application is true and complete FIRM NAME' / , LIC.NO.: AIIIPPILVLicensee: OfV f,�,` % J Signature a LIC.NO.:3 c go q p (Ifapplicable t- nix" AIMF n , line.) Bus.Tel.No.. 13 Address: i. di /i iv .�ar/ Alt.TeL No.: /Lr"ili `f .. *Per M.G.L.c. 47,s.5 -61, . cavity work requires Dep: e ent of Public a ty"S"License: Lic.No. ' ' J S OWNER'S INSURANCE WAIVER: I am aware that the icensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$