The URL can be used to link to this page

Home My WebLink AboutBLDE-22-004590 Commonwealth of Official Use Only .Ems, Massachusetts Permit No. BLDE-22-004590 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) 875 GREAT ISLAND RD Owner or Tenant CUSHMAN CLARE Telephone No. Owner's Address 4717 ESSEX AVE, CHEVY CHASE, MD 20815 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: Garage Wiring. 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 0 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 Ton Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine 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 Ballasts Data Wiring: Heaters Sinus 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 ❑ OTHER 0 (Specify:) cbe,. 280 _ ,6713 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. ` FIRM NAME: Jonathan R Hall Licensee: Jonathan R Hall Signature LIC.NO.: 11925 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:263 CAMMETT RD, MARSTONS MILLS MA 02648 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. I PERMIT FEE: $75.00 CD t.et/b4 g 1 4.127 P kii4-L, ctb cilviri RECEIVED ,, FEB ea&e 1' 2022 �r//aedachiaeella i,' DINGDEE'ARTM T OtfcialUse Only i" )1` — At o�.�"' s' Permit No. 22 S 9 u1r ervicee V BOARD OF FIRE PREVENTION REGULATIONS Rev.j/07cy and Fee Checked APPLICATION FOR PERMIT TO PERFOR ] lave blank MI work to be performed in accordance w M ELECTRICAL WORK with the Massachusetts Electrical Code M YPLEASE PRINT IN INK OR TYPE ALL INFORMATION) i �,527 CMR 12.00 City or Town of: Date: �z fly this applicationiy or the un of: �, YARMOUTH To the Inspector of Wires: 8t► lives notice of his or her intention to perform the elecMcal work described below. Location(Street&Number) Owner or Tenant 1 Owner's Address Telephone No. Is this n h permit i conjunction a buildinpermit? purpose of i n g Yes No ❑g (Check Appropriate Box) ! listing Service Utility Authorization No. Amps Volta Overhead 0 Und rd aS g 0 No.of Meters of F Amps /"--Volts Overhead 0 Undgrd seders and Ampacity g ❑ No.of Meters Location and Nature of Proposed Electric`,cork: be Y No. ota Lh of Recessed Luminaires ConI,tenon o the ollowin,table m, be waived b the ht .Na of Cell...Soap.(Paddle)Fans 'o.o for o Wires. No.of Luminaire Outlets Transformers KVA Na of Hot Tubs4' No.of Luminaires Generators ' Swimming Pool 'Ve n- o.e 'units KVA No.of Receptacle Outlets d' ❑ ❑ Bette Uni mergency 'ng -:� No.of OB Burners No.of Switches No.of Gas No.of Zones tt.t 'ao ec, ,n an,No.of Air Cond. o Initlatin Devices Y o.of Waste Dispose 'eat amp um, r Tons No.of Alerting Devices Totals: " ._ oas `o.o on a lea of Dishwashers Detection/ Space/Area Heating KW Local a�L Devices No.of Dryers Heating Appliances Connection ❑ Other 'o.o "a r KW tY yatema: HeatersKW 'o•o •o.o No.of Devices or ' uivalent N .A dro S' ,s Ballasts Data Wiring: Y m+sssage Bathtubs No.of MotorsNa of Devices or ' ,uivalent OTHER: Total HP e ecommun : , gg Na of Devices or ' ,nivtalent Estimated Value of Electrical Work: Attach additional detail ff desired,or as required by the! Work to Start IG 1 Q)-, ___ (When required by municipal Inspector ofWires. INSURANCE CO Inspections to be pal policy.) COVERAGE: Unless waived by the requested accordance with MEC Rule 10 the licenseeSURAN E Cdes permit for the and upon completion. proof of liability insurance including"co n"coverage performance of its subs al work may undersigned certifies that such coverage is in force, mpktal operation"coverage or substantial issue unless CHECK ONE: INSURANCE g and has exhibited proof of same to the equivalent. The JK ONE: CE BOND0 (Specify:) permit issuing office. I certi 0 OTHER FIRM NAME:--0 c and pe ses ofperlury,that the Information on this application is true and corer License: 00.} err ,�,, piste pjappllcable en�3 exempt to/he/ic e number line.) Signature. LIC.NO.: Address: LIC.NO.: l gd�jy; ape!'M.G.L.c. 147.s.57-61. � INSURANCE security`VOA requires Bus.Tel.No.�SdR�.Igp-sr=_ RANGE WAIVER: I sire aware Department of Public Safety••g^License: Alt.Tel.No.: OWNER'S law. By mysignature that the Licensee does not have the liabilityi Lic.No. —_ required la gnature below,I hereby waive this requirement. I am the(check one Slgntaturere� nsura!!ce coverage normally Telephone No. TFr owner's a;ent. PERMIT FEE:$