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Home My WebLink AboutBLDE-21-005609 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-005609 $ 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:3/29/2021 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) 19 INDEPENDENCE RD 5V`COS — 237✓9/0 0o Owner or Tenant Matthew Hughes Telephone No. Owner's Address 19 INDEPENDENCE RD,WEST YARMOUTH, MA 02673-1515 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: Renovations to basement. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Abov No.of Emergency Lighting No.of Luminaires Swimming Pool grnd.e In-❑ grnd. ❑ Battery Units No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALARMS I 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 Local 0 Municipal 0 Other: No.of Dishwashers Space/Area Heating KWConnection Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or No. No.of No.of Data Wiring: No. Water KW Signs 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 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: LIC.NO.: Licensee: Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.N o. Address: *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 (PERMIT FEE: $75.00 I Signature Telephone No. C2EA.964"/ 6G4+0. flA/ Y17f.SE 07-A fin) fO'4 f L' �j Official Use Onl �o rruwnu ta[�t o�I//aedact _ '. Permit No. " M Occupancy and Fee Checked J BOARD OF FIRE PREVENTION REGULATIONS [Rev. Iro7] (lYe blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code AMC),527 CMR t 2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g_.2 City or Town of: 7 >c�Z/ , fix To the Inspec or of Wires: �� v�c,� Q) By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ' Location(Street&Number a d e im.jet,.ce.._Pr - aat�btvne or Tenant {�'l - { e �-� �,r s Telephone No.02 , 99 t() S Owner's Address f V 1 i,e� e',, r. t J2✓ l.-1 ,eV ova tt SI Is this permit in conjunction with t building permit? Yes.o- No ❑ (Check Appropriate Box) 0 Purpose of Building I7 es t cte w c£' Utility Authorization No. Existing Service ,o,i Amps /La /Lr() Volts Overhead 2 Undgrd❑ No.of Meters / zkNew Service Amps /- Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampadty ``z€ Proposede0. j .fit L ` ,0 "VocelAyel, l Location and Nature ofElectrical Work: ��g �� / '"' t V el O rcr4- t 5c) ire fort.. //rl Completion of the followingtabk may be waived by the lns�ect r of Wires. of TT ,, No.o otal No.of Recessed Luminaires f. Na of Cell.-Scalp.(Paddle)Fans,,. Transformers KVA , , No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of emergency Lighting , No.of Luminaires Swimming Pool �d. ❑ mod, ❑ Battery Units -QF No.of Receptacle Outlets 12" No.of Oil Burners FIRE ALARMS No.of Zones �^ No.of Gas Burners No.of Detection and No.of Switches Initlating Devices ^ -TO No.of Ale Devices i 4 No.of Ranges No.of Air Cond. Tons 11� Heat Pump Number Thus_ I KW__. 'No.of Self-Contained No.of Waste Disposers Totals: Detection/Aler�Dewlces HeatingKW Man Other. No.of Dishwashers Space/Area ��-❑ Connection ❑ Heating Appliances KW 3'Systems:* No.of Dryers No.of Device:or Equivalent No.of Water KW glans Data Wiring: No.of B°�� 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 o El trical Worl 300 a.-- (When required by municipal policy.) in accordance with MEC Rule 10,and upon completion. Work to Start: , �c 2.1 Inspections to be requested INSURANCE CO RAGE: 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 certifr,under the pains and penalties of pedury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.TeL No.: Address: Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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)❑owner 0 owner's agent. Owner/Agent Signature Telephone No. S'bn=�37 6 PERMIT FEE:$ � '