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Home My WebLink AboutBLDE-21-007194 Commonwealth of Official Use Only :,. '►S� Massachusetts Permit No. BLDE-21-007194 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:6/10/2021 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) 54 WEST GREAT WESTERN R Owner or Tenant BURGESS HARRY V TRS Telephone No. Owner's Address BURGESS DOROTHY I, 54 WEST GREAT WESTERN RD, SOUTH YARMOUTH, MA 02664 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: Upgrade panel,wire split NC, &NC system. Completion of the following table may be waived by the Inspector or.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- ElNo.of Emergency Lighting g 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. 2 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 ❑ Municipal 0 Other: Connection 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 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: Charles K Swanson Licensee: Charles K Swanson Signature LIC.NO.: 12895 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:718 CEDAR ST,W BARNSTABLE MA 026681300 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 Commonwealth of Massachusetts Official vse only y r w_- t; --J Deparbnent of Fire Services r r�, �=- --7( 9 4 . Occupancy and Fee Qicd ed BOARD OF FIR E PREVENTlON•REGUt.AI't4NS fRev.95] Novbunk) i . - APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AR worktebe performed ta w*tbsifissadasettsElectrical Co&(btEtC),52?CUR 12.00 (PLR ASIR PRINT MINK ORTZE 4LLINpOli4LT101 ) Date: . ._-Z, 1-( City or Town of: YcJ rw6v h, To the Inspector of Wires: - By this applicatirnthe undersigned gives notice ofhis or her intentioa to perform the electtiaalwst did below. Location(Street&Number) Stj 1.0c 51 G Jt c i (i I rtirA, pc)( . Owner or Tenant • 4Z5 5 8 Ud-,-.1c S¶ Telephone No. Owner's Address Is Ms permit in conjunction with a building permit? Yes 0 No ilir (ChedcApp-roprlateBo:c) Purpose of Building - No. Kdsftag Service Amps / Volts .Overhead 0 -Undgrel 0 No.of Meters • New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Prop Electrical Work v_{ c.74-cc,c.. tir-ci c4.( P6►r-t , 0 e it. 7 1 va- (c5s ' (' Lice( e c /•, 'CG [Wtt'ritch1 iy5lc iAl Cotnpktion Of �tabk may be waked. by �of Wires. No.of Recessed I aires . NaofCif Sesp. )Fan otai E:PA No.of LuminaireOutlets No.of Hot Tubs • - Generators - KVA No.of Luminaires PoolAbove 1 ❑ BBal yu ntis No.of Rec cle Outlets No.of Oil ALARMS JNo.of Zones No.of Switches No.of Gas miaowDevices No.of Ranges • No.ofAir Cond. 2 Total • •1 'No. qf Alerting Devices . ITT QT�saa®s No.of Waste Dbpose rs H TI=I N tT`'i i Li t �Alertine Devices - No.ofDidnvashers SpudAreaHeating_KW Local❑Mani " No.of Dryex3 Cosa- -oa 0 Otleer Rooting M� KWNo.of Devices or Equivalent No.of Water Kw NO. N Data • No�Devices or : .uivalent No.Hydnanassage Bathtubs No.(Wasters Total HP -? : OT'SgR: Na.of Devices or • Estimated Value of Electrical Work 3 ' eC Attack odaizkeditiono dotalfdieskadora requiresbytiie.b oft Work to Start: L` �.( Inspections h3' apai policy.) • INSURANCEoStartZ--1-COVERAGE! to be in accordance with MSC Ride 10,sad upon co - • the licensee-provides of by the owner,nopermit�dmpofe lwaitmayissue • proof ]mbstityin � operation" or its sobstainial equivalent. underaigued certifes that such coverage is in force,and has calked proof of same to the permit issuing office. Tka aancx one. INSURANCE it BOND 0 OTHER 0 (Specify) • I radar t ar�andpens eft* that the�n an this kreeeand FIRM NAM: L.�h.c�e S SLx(A 5'e v\ complanA License= LTC.NO.: (�, �1 L ,-e "std� , p.t a tureY� Ise.NO.: 3 t6 t 3 ��1t�• �zc�c4` f C 1 7 5t66� Nnc` Tel.No.: . a �7'n G(6( *Security I.icenserequired for Ns v ifcense Alt Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licetwee does not have requiredBy ray ebelaw,!hereby waive this regui eme t, Iam the(check p D owner's TeleRhone No. •P 'MI6 . ca�7 EMAU.ADDRESS: VVLo 17 c(� tt S t CO Wt • . . The Commonwealth of Massachusetts • Department of hrdrrstrhrlAcdder s - • 1 Congress ;�-= . . ga an, tt2Xld-2017 _a; _ -wwNt govie . Wallows'Com TO, 11 1LXI W11 ITSZ EOUITI TG=sal t ry .�` , • t ii,•L 14.1.t_ - _ - t c ame r Address: 1(E Cr-Lv— S l .0 a. � Y- 4 #._ S�F' ?3�- G(o C • keret se employee?��' Meek Ilse SppreprIste, Type oiproJed(required): it"Iama asnl►lnYawttlt Rem . any away.[No wades's'comp.Mamma requireda '9. ['Denotation .. • 3[]IamaLaneo+emrdomsAaaacuaysalE teloveslow,comp.ioseaumenque. d'jt to E • .01 sol a homeowner end mil be Heim conmermstoconductellwmkonmy properly.iell a e6utalloa e�rlfswe oce arms solo 1x"ssBlooded or a dditions pupal=with= 12 :plumbing repairs or additions 30Iamar eemplwoyelesb o ewodoeemop ed moai d_ - 13.QR0"fi 8 14.0Odler • a we,osacospoc IV,§T{' .a�we b.+►a meplo to;• esserompolioy — — • *Aesr 6M Wadimastaleofficatffiasect� ow information. t wmRwho us ell wedisoddmmmtao a neat sstanewa fdaoic ddifeesehled s d dm sew ease selrem state wledie ereotaws” o bave Iftthesabwoofm slime 6„k " osdie'redoes' aaoolxc. telow it the policy 1.ens as ems"that pravf&ngworkers'cs furV d site information. Insurance CompanyNamm Expiration Date Policy#aa Self-ias.L . - Job Situ Addthey end expiration..date). Attach a copy of ' p ation policy declaration page(showing ?SA.b a prmishablebyaffiattpto S1,�.0 Fat'htae to swum °� �r1�frLa 152,§ to S2'SO.00 a as well as civil pe in the form ofaMP WORK ORM&and afineofup . and/ adds statement mate to the Mace of of the DIA for insurance • �y the violator.AceFY � coverage verification. -- - — ----in n�above istrue and comet OfficialI da hereby owe ander the pains am 1 penalties*forint,that the use only. ,o nitwits ins this area,tobs completed by cityas town officiaL Permit Cite or Town: Issuing Mahon! (circle 2.Bai t 3,City Clerk d. S.PlumbingInspector L Beard ofHea 6.Other yhoneg' • ConhctR -- - I e $0U --- - - ---__.-- --—