HomeMy WebLinkAboutBLDE-22-004943 Commonwealth of Official Use Only
'i:l�''7_� ' Massachusetts Permit No. BLDE-22-004943
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) 9 HOLLY LN
Owner or Tenant Susan Bergeron Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap r 'kite B `
Purpose of Building Utility Authorization No. `..:, I).._.
Existing Service Amps Volts Overhead 0 Undgrd 0 No. ��r�e `�, `
New Service Amps Volts Overhead 0 Undgrd 0 No.of fhb '
Number of Feeders and Ampacity
C116Location and Nature of Proposed Electrical Work: Air handler&condenser. y, ,f,,,
Completion of the following table may be wai ed 1 o f In ires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tot.
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above o In- ElNo.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
Initiatine Devices .
No.of Ranges No.of Air Cond. 1 Ton l No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 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: ANDREW G THOMAS
Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:7 ECHO LN,CHATHAM MA 02633 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: $50.00
- - IL. Commomwatakh of Ma4.40,4u.sidis Official Use Only
PP:----nait No
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2spartmersi of 5ii.Sarvks3
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS
.4( Rev, 11(P) (leave blank)
APPLICATION FO PE IT TO P RFO - EL CT- ICAL 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: NAckcc,In -14 20 2.2
City or Town of: \la(t\400-r-IA 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) CI 1-kolVi Ls\ .
i Owner or Tenant 0 c,ky\ ecAr5.c.r Ov\ Telephone No.cii4)-410-•894‘
Owner's Address 1 Heilt7 I Ikt
Is this permit in conjunction with a building permit? Yes D No 2 (Check Appropriate Box)
Purpose of Building (T 51 )tqj,4 ( Utility Authorization No.
Existing Service 10') Amps 1 ci / t-16 Volts Overhead El Undgrd E No.of Meters /
New Service Amps / Volts Overhead E Undgrd [1] No.of Meters
Number of Feeders and Ampaclty
Location and Nature of Proposed Electrical Work: Ar‘c.. A,r iikei)1-t( 0, 1 A c CO A ti f n Y,r
Completion of the followinktable may be waived by the ktspector of Wires.
No,of Tots!
No.of Recessed Luminaires No.of Ce11.-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KNA
Above r--1 In- ri No.at Emergency-I:kiting
No.of Luminaires Swimming Poolgrnd. L-1 grnd. " Battery Umts
No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones
4
:No.of Detection and
No.of Switches No.of Gas Burners Initiating Devices
Total
No.of Ranges No.of Air Cond. No.of Alerting Devices
Tons
HeafPump Nuniber Tons KW 4No.of Self-Contained
No.of Waste Disposers Totals: --V .'k'' ' Detection/Alerting Devices
ri Munkipal 0 ,
No.of Dishwashers Space/Area Heating KW Local L-, Connection tItucr
— a
Na.of Dryers Heating Appliances KW Security Systems:1
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts 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: 0°I) (When required by municipal policy.)
Work to Start: ('');kt(.11 7,),j1 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 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: -T.VARS.4 GS q"1 WiT1C.C11 'CirklICeS I AC... LIC.NO.:21152 'A
Licensee: N(Nekt ev.i --mo vvtcA 3 Signature a.eis- 1-02,..--- LIC.NO.:.
(If applicable,enter"exempt-in the license number linc.) Bus.Tel No.: ta 17 51 L'.-S.7T
Address: 1 fctnO I n. c hailnam Oleo;7, 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 insurance coverage normally
required by law. By my signature below,1 hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: 3