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Home My WebLink AboutBLDE-23-004387 --.�' '�'� Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-004387 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:2/8/2023 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 de e,cl below Location(Street&Number) 9 OLD CASTLE.RD 10 Owner or Tenant HAGER JOANNE L Telephone No. Owner's Address 9 OLD CASTLE RD, 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: Miscellaneous work per attached. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 30 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above ❑ Irnd. ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool g Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 Ton No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Euuivalent Heaters KW No.of No.of Ballasts Data Wiring: Signs No.of Devices or Euuivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 ofperjury,that the information on this application is true and complete. FIRM NAME: Douglas K Tiernan Licensee: Douglas K Tiernan Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 28753 Address:437 COUNTY RD,WEST WAREHAM MA 025761503 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 r. t\--?12- 11 4.seg_. (sof gz., (2_,,„,.„-cr,2.) 1 ci /2/'z �- tu' 'I/e41 2-> (j'if fee RECEIVED A. �r yyy�j EB O 8 2023Coonu-nweat of ii/adaacbude id Official Use my l.firs Serviced Permit No��Z3' 7 sptrf+nsnl o t �j- ��DING DEF'ARTfUiEN i yet• - ==•=•_'=' 'REVENTION REGULATIONS [Rev.Occupancy/0] (leave blank) d Fee kked . APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' k. 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: e .e, ,City or Town of: YARMOUTH To the Inspector of Wires: MI By this application the undersigned gives notice of his or her intention to perform Location(Street&Number) S' the electrical work described below. Owner or Tenant (2 0p-p, 7)4 r :•"'r.4a;s4.-1.,,cvT'.4 i_e_. Telephone No. Owner's Address /9 P17tl c- 3 7 4..d Is this permit in conjunction with a building permit? Yes N Purpose of BuildingLT No 0 heck Appropriate Box) \ ," �` � Utility Authorization No. Existing Service ?E.12 Amps /vim/ Ze-fd✓olts Overhead 0 Undgrd G-V-7No.of Meters New Service Amps / Volts Overhead❑ Undgrd Number of Feeders and Ampadty g ❑ No.of Meters 14, : Location and Nature of Proposed Electrical Work: _7744,.._ c,-7-5 " Lb Completion of the followinktable m be waived by the In vector of Wires. va No.of Recessed Luminaires No.of Cell.-Sos . No.or she p (Paddle)Fans Transformers Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- No.of I mergencyUnits Lighting '') No.of Receptacle Outlets grad. ❑ �"d' ❑ Battery No.of Oil Burners FIRE ALARMS ,No.of Zones 4` No.of Switches No.of Gas Burners 'No.of Detection and 1',I No.of Ranges Total Initiating Devices No.of Air Cond. Tons No.of Alerting Devices Na of Waste Disposers > Heat Pump I Number Foils J KW No.of Self-Contained Totals: "" "r" '1' Detection/AlertingDevices Na of Dishwashers Space/Area Heating KW Local❑ Municipal No.of Dryers Connection ❑ � tY Heating Appliances KW Security Systems:* No.of Water KW No.of No. No.of Devices or Equivalent HeatersHeaters of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring. OTHERS No.of Devices or Equivalent Estimated Value of Electrical Work: �� &� Attach additional detail if desired,or as required by the Inspector of Wires. 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 c�ov s in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE a BOND 0 OTHER 0 (Specify:) I certify,under the pains and penaltiLpedury,that the Information on this application is true and complete. FIRM NAME: .pc,.,j`y � ) � n. Licensee: �'. Le"�rr,,...7,.rel� Signature LIC.NO.: � �� (If applicable,enter exempt"in the license number line.) - LIC.NO.:� �T�-q Address: 37 ��--��-yy Bus.Tel.Na:_t 7 �c��e� *Per M.G.L.c. 147,s.57-61,seoufity work requires Department p Public Safety"S" 3C: Ast.Tel.INo.: 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 owner's a ent. Owner/Agent Signature Telephone No. / _ P PERMIT FEE:$ fJ.1 I"L