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Home My WebLink AboutBLDE-22-000033 Commonwealth of Official Use Only f; Permit No. BLDE-22-000033 -'�. Massachusetts �11-s9 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:7/2/2021 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 CAPT CROCKER RD Owner or Tenant WILLEY KIMBALL R Telephone No. Owner's Address WILLEY NICHOLE R, 19 CAPT CROCKER RD, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap late Box) Purpose of Building Utility Authorization No*.tiil Existing Service 100 Amps Volts Overhead 0 Undgrd 0New Service 100 Amps Volts Overhead ❑ Undgrd ❑ r 4) Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. Completion of the following table may be 63841 . 't, tor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of tal Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators A 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 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Lloyd R Smith Licensee: Lloyd R Smith Signature LIC.NO.: 15688 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 1ST ST, MELROSE MA 021764010 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 o j///ask:schw Official Use Only l` i'i �� ®c7 Permit No. ?/7i� C10 33 lil o�' = e nt ..?ire�ervrce.4 -" Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECT ICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M ),5 CMR 12. (PLEASE PRINT IN INK OR TYPE BALL INFORMA )) pate: ^J 24F City or Town of: \,,, avin Q` ��1 , o the Inspector o Wires: By this application the undersign fives no' e of his or he tentiQn to perfo the electrical w rk escribed below. Location(Street&Number) (^` if) � Owner or Tenant Ni,�,C� U R t \ Iel Telephone No. 3 Owner's Address ..rn '\ [�,sc VA/ Is this permit in conjunction wi uilding permit? Yes ❑ No (Check Appropriate Box) Purpose of Building "1 r Utility Authorization No. Existing Service 10Q Amps 120 /a` ow Overhead Undgrd El No.of Meters 1 New Service 100 Amps RC)/2.-ELvolts Overhead liir.. Undgrd❑ No.of Meters Number of Feeders and Ampacity •Location and Nature of Proposed Electrical Work: 100 ��(pc Completion of the following_table my be waived the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf T 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 ) of Detection and No.of Switches No.of Gas Burners No.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, Cystems:* onnection No.of Dryers Heating Appliances KWN secuof Devices or Equivalent ) No.of Water KW No.of No.of Data Wiring: 9 Heaters Signs Ballasts No.of Devices or Equivalent ) No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: t.;S?.) Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o Elec 1 ork: C� 1 • (When required by municipal policy.) Work to Start: 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C E: 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 ceyrage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE, BOND ❑ OTHER ❑ (Specify:) I certify,under theolns and pe of perjury,that information on this lication is true and complete. 3 FIRM NAME: LIC.NO.: • Licensee: Signaturc. Q LIC.NO.: %----16 ~`1- (If applicable,ent "exempt"in the license amber line.) Bus.TeL No.• Al Address: t' -in 5-11".ol s h &t U Alt.Tel.No.: Is i tiar� *Per M.G.L.c. 147,s. -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 C required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE:$ Signature Telephone No.