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Home My WebLink AboutBLDE-22-005982 o* r j(\l/� Commonwealth of Official Use Only 114 `' Massachusetts Permit No. BLDE-22-005982 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:4/19/2022 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) 73 BRAY FARM RD SOUTH Owner or Tenant Andrew Varley Telephone No. Owner's Address 73 BRAY FARM ROAD S,YARMOUTH PORT, MA 02675 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rewire bathroom. 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 ❑ 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 Initiating Devices No.of Ranges No.of Air Cond. 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 Ballasts Data Wiring: Heaters Siens 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: DANIEL J PECKHAM Licensee: Daniel J Peckham Signature LIC.NO.: 26830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LN, MARSTONS MLS MA 026481629 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. PERMIT FEE:$75.00 at441 yv /cam_ tl,i)kii- . 7 z� _. wRECEIVED ...,cl, APR 1 9 2022 C0, 'wealth oil Mao ach ffd Official Use Only ■ 4'4; DING DEPARTM �J p 01 gin Jsrvicsd Permit No. �-- --=� I j� 11 �.1`; Occupancy and Fee Checked ,,�,, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK I All work to be performed in accordance with the Massachusetts Electrical Code( C),521 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,/ j ci / 2_ ',1 City or Town of: YARMOUTH To the In pector 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 ISrn ` _ tt Owner or Tenant J' �� '� �G�"� »yil/,-e.4� V`{-�L`.-' Telephone No. Owner's Address I Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 11 Existing Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity c-- Location Location and Nature of Proposed Electrical Work: ,p ,I� .�,J 1\�"' Z.,.J L t,L-f 1-�ctl�'t-kov.0.3c vi ° Completion of the following table may be waived by the In ector of Wires. i[,. No.of Recessed Luminaires No.of Ceil:Sus . No.of sp .., p (Paddle)Fans Transformers Total No.of Luminaire OutletsKV' No.of Hot Tubs Generators KVA - No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting x grad. grnd. ❑ Battery Units No.of Receptacle Outlets No.of OH Burners FIRE ALARMS !No.of Zones - No.of Switches No.of Gas Burners No.of Detection and 11,1 No.of Ranges Initiating Devices No.of Mr Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump 11Vu_tuber Tons KW No.of Self-Contained - Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal No.of Dryers Connection ❑ Other tY Heating Appliances K�, Security Systems:* ' No.of Water KW No.ofNo.of Devices or Equivalent HeatersNo.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) 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 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 Xi _BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: (` LIC.NO.:�_ Signature ,v LIC.NO.: (If applicable,enter exempt in the license number line.) � Address: 0_ a1 �® Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety No.Safety"S"License: Alt.Tel.No. = OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n normally L� required by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent ■ owner ■ owner's a:ent. Signature Telephone No. PERMIT FEE:$