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Home My WebLink AboutBLDE-21-006301 for . Commonwealth of Official Use Only t, 41\ Massachusetts Permit No. BLDE-21-006301 ti BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:4/30/2021 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) 162 SUMMER ST Owner or Tenant Duane LeBlanc Telephone No. Owner's Address 162 SUMMER ST,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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Basement lights&switches. Receptacles. Completion of the following table may be wa',•: by the Inspector of Wires. No.of Recessed Luminaires 14 No.of Ceil: No.of OP Total Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets 14 No.of Hot Tubs Generators e A Pool Above ❑ In- ❑ No.of Emerge y I htinip //, No.of Luminaires Swimming grnd. grnd. Battery Units *1 No.of Receptacle Outlets 45 No.of Oil Burners FIRE ALAR !'' lgi&. _Zone 0 co- No.of Detection an i\ oJ� o1i No.of Switches 16 No.of Gas Burners Initiating Devices cQ Total No.of Alerting Devices '"j; No.of Ranges No.of Air Cond. Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Space/Area Heating of Dishwashers P KW Local 0 Municipal Conne unici alConne Lion 0 Other: HeatingAppliances KW Security Systems:* No.of Dryers PP No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: No.Hydromassage Bathtubs No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. required bymunicipal policy.) Estimated Value of Electrical Work: (Whenq P P y' 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 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Alt.Tel.No.: 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 ❑ owner's agent. Owner/Agent Signature Telephone No. 'PERMIT FEE: $75.00 C2-( ?I'V P--e- t:57:1r. Cr(g_ ' ia) lk1►Q-(. 71i/ -� ram' q�,�` y��j�j r- C /�ommonwsaith oil t/Iaadadowettd Official jUse Only /� i' ig ""t cc�� cc77 Permit No. S� `— (0.3 6 1 " - 1Jspartmsnt o��tira�iwasd I i- ;' Occupancy and Fee Checked `yes BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (cave blank) 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 1] City or Town of: YARMOUTH To the I pecto of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) I(p a S(A,,eyi al e r J4, Owner or Tenant '/,(,in e, ii Ol y)C, ,T/eelephone No.r �26 o-2-i 2-Qq/( Owner's Address )b�. S't,(.r�' htr 5.6 tiger p r i- t l k Q 'V Is this permiitt in conjunctionwith a building permit? Yes No ❑ (Check Appropriate Box) Purpose of IMPto 1g ),0 (ref„i f( ittiljj CA(it't BAT*Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty ; Location and Nature of Proposed Electrical Work: ,(jasr,(�l'Y�P 't /l c S 6 (pS St()1.�k et d, c Jt' its ( )rt► 2O 4 ) add I1 ) #llc.�le&- j (� u'. Completion of the following table ay be waived by the Inspector o fires. / otal 't No.of Recessed Luminaires ( i No.of Cell.-Snap.(Paddle)Fans Transformersr.or TVA ,,`r f KVA No.of Luminaire Outlets !if No.of Hot Tubs Generators KVA ram, -_ No.of Luminaires Z gwimming Pal Fund.Above ❑ I"it- ❑ No.of Emergency Lighting nd. grnd, Battery Units No.of Receptacle Outlets if No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches f it, Na.of Detection and Na.of Gas Burners Initiating Devices Total 1 '1. No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons_ . KW No.of Self-Contained - Totals: .. - - Uetection/Alertin Devices No.of Dishwashers Space/Area Heating KW al❑ Connection ❑ Other Cantiection No.of Dryers Heating Appliances KW Security Systems:4 No.of Devices or Equivalent _ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent iring No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsofDevices or q No.of Devices Equivalent _ OTHER: / Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical W rk: #( Q e) (When required by municipal policy.) Work to Start: 1 tL spections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: n ess 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 ❑ 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 LIC.NO.: (If applicable,enter"exempt"in the license member 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 in:_suptice coverage normally required by law. B y ' re ,I hereby waive this requirement. I am the(check one)[ owner ❑owner's agent. Owner/Agent ////,, �+ / Signature Telephone No.PAC/2/2- 9/4 PERMIT FEE:$ Cat.t.N.1 %'�A yCo.vv^s N 10 0.4 'e.,�t . $a Q..,G.c.L, oarc.,r`c o .