The URL can be used to link to this page

Home My WebLink AboutBLDE-22-007072 Commonwealth of Official Use Only ► Massachusetts Permit No. BLDE-22-007072 _ 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:6/7/2022 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. � 7r�� ^ sue Location(Street&Number) 55 PAYSON PATH J/J v Owner or Tenant Amanda Sears • Telephone No. Owner's Address 55 PAYSON PATH,WEST YARMOUTH, MA 02673 Aii4r) Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Chec Ap ' r Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 ... New Service Amps Volts Overhead 0 Undgrd ❑ 'i of,��y,•rs ,� 8 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Bedroom � . lb Completion of the.following table may be waive •', or of Wires. No.of �t I No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- CINo.of Emergency Lighting No.of Luminaires Swimming Pool ❑ grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS (No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained Totals: Detection/Alerting Devices Local ❑ Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or No. No.of Water KW No.of No.of Ballasts Data Wiring: Signs No.of Devices or Equivalent Heaters 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: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule10,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: Licensee: LIC.NO.: Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address: *Per M.G.L.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 owner owner's in ranee coverage normally required by law. But my signature below,I hereby waive this requirement.I am the(check one) Owner/Agent PERMIT FEE: $75.00 Telephone No. Signature Zixr a 5' ( g -e (pit at-- e ./ r, Ve e l C l ill y/-2,1X-Z _RECE �VE ® o d Qa of /// Official Usc Only Ma�eacA� (�6 20�� Permit No. ?i2'7 c7 7✓ JUN , OT ire SsrvK� Occupancy and Fee Checked REVENTlON REGULATIONS Rev. 1!07 1LD (leave blank bBy=__ ---'_ 'J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK O All work to he performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 S (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Co ( 31- • City or Town of: i�i,,(ryA,/,‘ 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) ,l5 'o vo Owner or Tenant Porai Seivi Telephone No. S 1-1'I(41 Yk3 •O Owner's Address SS u1 Cr Pt�* j i S 1 A✓ L NAG Oil`'U t• Is this permit in conjunction with a building permit? Yes EMI No E (Check Appropriate Box) Purpose of Building (. ZcY ► . Ut*ty Authorization No. Existing Service Amps / Volts Overhead Undgrd - No.of Meters � # { New Service Amps / Volts Overhead❑ Undgrd _ No.of Meters CNumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (5,eek .o c. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ,...,, Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of AlertingDevices No.of Ranges No.of Air C arid. Tons Heat Pump(Number lTons. __.IKW No.of Self-Contained No.of Waste Disposers Totals:( Detection/Alerting Devices Other No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ HeatingAppliances KW Security Systems:* No.of Dryers PI No.of bevices or Equivalent No.of Water No.of No.of Data Wiring: KW Ballasts No.of Devices or Equivalent Heaters Signs 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: 1. 0Gt _ (When required by municipal policy.) Work to Start: C., "i-3-7-- 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: Signature LIC.NO.: Licensee: Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) uAls.Tel.No.: Address: *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 trance coverage normally required by law.,By my signature below,I hereby waive this requirement. I am the(check one) owner 0 owner's agent. Owner/Agent 1 Telephone No. ��'`►3�3 l PERMIT FEE:$ I Signature \, ,c4n.x