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Home My WebLink AboutBLDE-23-003923 Commonwealth of Official Use Only fi g Massachusetts Permit No. BLDE-23-003923 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:1/18/2023 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 described below. Location(Street&Number) 50 PARK AVE Owner or Tenant LILIEBERG CARL J III Telephone No. Owner's Address LILIEBERG LAURA J, 908 LINDSLEY DR,VIRGINIA BEACH,VA 23454 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: Wiring for TV's, Network, &Speakers Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total 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 No.of Switches No.of Gas Burners No.of Detection and Initiatine 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/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: Glenn F Hayes Licensee: Glenn F Hayes Signature LIC.NO.: 85 (If applicable,enter"exempt"in the license number 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: 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: $45.00 /rl J' jtrdj ,. : RECEIVED rnez,'get •,41 'nava[th 182023 y� ` -- ,� AN /'l�sachuaea�fe �O--f-fi�cial Use Onl r_-11, ?. ,minim,4 cc�7 �7 Permit No. l!��--3 J 31'27 r I N G DEPARTMENT .tiro Jsrvits6 t Occupancy and Fee Checked 1�'' 'F----.•••'...=-='— : PREVENTION REGULATIONS [Rev. l/07j (leave 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: City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives -tic of hi or her intention to perform the electrical work described below. Location(Street&Number) 5,-r.) fj e Owner or Tenant n 0-j/I '° Telephone No. Owner's Address Is this permit in conjunction with a b7ding permit? yes ET No ❑ (Check Appropriate Box) Purpose of Building t t!r r� Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd g 0 No.of Meters New Service Amps / Volts Overhead 0 Undgrd g ❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: 7 .'S` /(/.0(4 trek to c S??eq/Ce,I o, v Completion of this following table mf be waived by the Inspector of Wires. 11.0 No.of Recessed Luminaires No.otCeil.-Snap.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires • Swimming Pool Above ❑ In- No.of l!mergency Lighting grnd. grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones A. '-. No.of Switches No.of Gas BurnersNo.of Detection and i;r Initiating Devices Total No.of Ranges No.oo Air Cond. TonsNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:I"'�""" "' '""'"" "'� Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ 'wet' No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent HeatersNo.of 02 KW Data Wiring: Signs Ballasts No.of Devices o 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 Wo as`-� (When required by municipal policy.) Work to Start: (-(y In pections 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 cov ge 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 ains arms lief o f j 7 S,�tphat,�tCe In anon on this application is true and cotnpiete FIRM NAME I ' `�t `J ( LIC.NO.: ) k0 Licensee: ( Jre', l ,�,f Signature LIC.No.: (lfapplicable,ent r'milt;ih the c rum lin Address: t (ixvr( ',r e S�� //i4- a)3-7j�- Bus.Tel.No.: /7 - �G p *Per M.G.L.c. 147,s.57-61,securitywork requires / 1 Alt.Tel.No.: 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. signa b ow,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent. Owner/Agent Signature Telephone No. /-19^?� I PERMIT FEE:$