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Home My WebLink AboutBLDE-22-004975 �'co Commonwealth of official Use Only Massachusetts Permit No. BLDE-22-004975 gift: 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:3/8/2022 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) 53 PROSPECT AVE Owner or Tenant TRACY WILLIAM D Telephone No. Owner's Address 53 PROSPECT AVENUE,WEST YARMOUTH, MA 02673 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: Receptacle for water heater. 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- ❑ No.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 Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Ton Heat Pump Number Tons 1 KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices ❑ Municipal p Other: No.of Dishwashers Space/Area Heating KW Local Connection Appliances KW Security Systems:* No.of Dryers Heating pp No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs 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 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: JACK GRIFFIN LIC.NO. 54823 Licensee: JACK GRIFFIN Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel. Address:26 JOANNA DR,YARMOUTH MA 02664 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. I Owner/Agent 'PERMIT FEE: $50.00 Signature Telephone No. b 11(u6 T 1Z-. RECEIVED ,. MAR 0 8 2022Co , ,sad of?a Official Use Only �a Permit No. °22—1.-C"l. 1 V - g i, a NG DEPARTME •, si_l _cow. V Occupancy and Fee Checked NTION REGULATIONS [ }1 r BOARD OF FIRE PREVENTION REGULATIONS (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK t. All work to be performed in accordance with the Massachusetts Electrical Code *-,, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 3 r Clty or Town of: '%T �9 J�l�� To the Inspe r of Wires: ' perform the electrical work described below. By this application the undersigned gives npotice of his or her intention to Location(Street&Number) , 3 r 14 5 r (+ I V_e Owner or Tenant 1( f I C Telephone No. (� / 7—y�(I—0936 ,, Owner's Address ",S V 1 '0 e Ci . ., U V Is this permit in conjunction with a building permit'. Yes ❑ No [r (Check Appropriate Box) Purpose of Building Utility Authorization No. / Volts Overhead 0 Undgrd❑ No.of Meters Existing Service Amps Undgrd 0 No.of Meters New Service Amps / Volts Overhead El Number of Feeders and Ampadty Location and Norton of Proposed Electrical Work: f}6 e) (--1(J) ( & wa-i er Neal °' 1 Completion of the followingtable mug be waived by the Inspector of Wires. No.of T tl No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans> Transformers KVA C No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting mot° No.of Luminaires Swimming Pool �d. ❑ mod, ❑ Battery Units No.of Receptacle Outlets No.of OU Burners FIRE ALARMS INo.of Zones No.of Detection and <: No.of Switches No.of Gas Burners Initiating Devices Total i No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump Number n ., I KV..'._._w... No.Detection/Self-Contained s No.of Waste DisposersTotTotals:I Tos��T Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other No.of Dryers Heating Appliances KW -Security o of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications W�: Total HP No.Hydromaasage Bathtubs No.of Motors No,of Devices or Equivalent OTHER: Inspector Attach additional detail if desired or as required by the ►spec of Wires. li Estimated Value of Electrical Work: 2� G (When requiredrequiredmuni by �policy.) Work to Start: ?/1 Q /z 2_ Inspections 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 provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned e pro certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) the ,, , and penalties of perjury,that the information on this application is true and complete. I certify,under ` LIC.NO.: s'1 g�3 o FIRM NAME: ��.i�.��-� [�!�s!i� I✓S :�� LIC.NO.: r / rK C, / Signature GJ Licensee: Les,b,�„-.. � Tel.No.:�7 R^`j��'"�� T (If applicable,enter exempt"in the license number line.) Bus..Tel.No.: Address: 4.C .70 q hh<� 0r y t✓'Ivietfi n i 1W?1 01'4� *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee eon I am the not have(chehe ck ility ony)insurance ❑owner coverage er owneroris ally required by law. By my signature below,I hereby waive this requiters► 1 PERMIT FEE:$ Owner/Agent Telephone No, Signature