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Home My WebLink AboutBLDE-21-005934 Official Use Only Commonwealth of t Massachusetts Permit No. BLDE-21-005934 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:4/14/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 79 STANDISH WAY Owner or Tenant DROBNIS BRUCE A TRS Telephone No. Owner's Address DROBNIS JOAN TRS, PO BOX 1364,ATTLEBORO FALLS, MA 02763 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: Install EV charger. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In- ElNo.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiatine Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine Devices Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW Local 0 Connection Security Systems:* No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent 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 that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE ❑ 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: DESMOND P CLIFFORD LIC.NO.: 33276 Licensee: Desmond P Clifford Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address: 14 MERRYMOUNT RD,W YARMOUTH MA 026734853 *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. I Owner/Agent I PERMIT FEE: $50.00 Signature Telephone No. • 14 CoiiimoawoallL 4//Iaosckso4 a Official Use Only c cc�� Permit No. EL\ - 613 ` ' • `` .1lsparsnl a�.tf++a�srvlua 1/4 s" Occupancy and Fee Checked \ BOARD OF FIRE PREVENTION REGULATIONS [Rev. lro7] (leave blank) .5 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL�WORK All work to be performed in accordance with the Massachusetts Electrical (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I3 )..1 City or Town of: --//4/u'a c 4 To the Inspect r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) —7 9 5-77I O-9 a N.' f") /1 b 141-41 MAO Owner or Tenant egli C t htel 6 to eps5 Telephone No. 5 z'=75-3-779 79 Owner's Address 1f 9 C Lil & 01 /`�fi?)) nraega fh i f►i,) • 0 74 0 Is this permit in conjunction with a"buildinng permit? Yes ❑ No Q/ (Check Appropriate Box) V Purpose of Building / Peat Utility_ty Authorization No. R Existing Service 100 Amps I -O // Volts Overhead L✓I Undgrd 0 No.of Meters I New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampadty 3 7L /0 0 Location d Nature of Proposed Electrical Work: 77 d (N Q ease i I OA? /2 t I,if.D.yw C v* ;;lg I -t UA 9-L L C'1 vCompletion of the followin&table maybe waived by the Inspector of Wires. ' No.of Cell.-Snap.(Paddle)Fans _No.of Tea formers Ttaall Z- No.of Recessed Luminaires No.of Lwninain Outlets No.of Hot Tubs Generators KVA 'tt No.of Luminaires Swimming Pool Above d. ❑ Ind. ❑ ni �Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices 11,1 No.of Ranges No.of Air Cond. Total No.of Alerting Devices ns Heat Pump Number Toms..._...1KW.....__..'NNo.of Self-Conte Devices No.of Waste Dbposers ned Totals:I I No.of Dishwashers Space/Area Heating KW Local 0 Co itn 0 Other No.of Dryers Heating AppliancesKW Security of Devices or Eauivaknt No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or=tient Telecommunications No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or F.W&int OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El 'cal Work: -Il 1 )4 0 (When required by municipal policy.) be requested in accordance with MEC Rule 10,and upon completion. Work to Start: 13 A 1 Inspections to for theperformance of electrical work may issue unless INSURANCE C RAGE: Unless waived by the owner,no permitpoverago or its substantial«luivalent. .The the licensee provides proof of liability insurance including"completedoperation"f of same to the permit issuing office. iundersigned certifies that such cov a is in force,and has exhibited prop ZZZ>r,�� .1r�3t�t� 3 3CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) $ Fe7/ I certify,under the pains and penalties of perj ,that the information on this application is true and complete l� /1't6Pn / CL'7� t`Z LIC.NO.: 74 b FIRM NAME: � G�/�✓ ' LIC.NO.: Signature T • Z o cf. Licensee: 0 L3/tioN 0 �- C Bus.TeL No.: 1.(-7 �7 (If applicable.e�ter"exempt"in he license line.) '""1” 1/ /31 A o.zt7J Alt.Tel.No.: Address: 1 4- Mt 1/144 r.-1 (,•l v>t A. "S"License: Lic.No. *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety insurance lly OWNER'S INSURANCE WAIVER: I am aware� the Licensee does not have e this requirement I am eth (che e kone}ility ❑owners❑owner's required by law. By my signature below,I hereby Ownerr/Acegent Telephone No. ` PERMIT FEE:$ Sign 313► 12Z Cat C, C Cal `tri`'S fr ;gRPlrCt- c rK*rs 300 i 0 _5 beitf, 690) -2_11 11444S "Win ca.54 V ( 06470, Coo V4- Ell °Welt Sv Trihi t14 611er h )(VC s-)_ c-4 44- _ / c� voa - P5L-ser- Uk ()G /cam0 l iltmeDeg ifo% I av IUo% of fC 71-rAl VP 73 -7 Z1tv c) 3 , icifvei