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Home My WebLink AboutBLDE-23-005114 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-005114 e.,,o, 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:3/17/2023 City or Town of: YARMOUTH To the Inspector of Wire By this application the undersigned gives notice of his or her intention to perform the electrical work described below. A I Location(Street&Number) 31 GROUSE LN Owner or Tenant CHARLES MILLER Telephone No. Owner's Address 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: Remodel living room, dining room, &replace panel. 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 No.of Luminaires Swimming Pool Above ❑ In-d. :INo.of Emergency Lighting grnd. grn Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local 0 Connection ❑ Other: Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs 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: (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:) l certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MATTHEW D KLINE LIC.NO.: 53620 Licensee: MATTHEW D KLINE Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address: 10 Nehoiden St, Harwich Port MA undefined *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 'PERMIT FEE: $75.00 Signature Telephone No. K1Pi- 3( 2t3 ( wo: ?...o-Atki L--/iu) tZc f1231 6 slid,* W 7`3//Z� �/ yy��jj�� Official Use Onl Commonwealth of ///a»achwelti qq — ccyy�� Permit No. ' it ii '' .L'cparbnent of.Dire Seraicei Occupancy and Fee Checked /56 '� _ F BOARD OF FIRE PREVENTION REGULATIONS1/07)d [Rev. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) �,CM)jt 12.00 (PLEASE PRINT IN INK OR_ 'YPE ALL INFORMATION) Date: // 1/ /"z-3 City or Town of:YAroloAA 1SIKVNI9611E4k- 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) , ii,^�3t v u_S�' L.C�1 C> C �L C�� 'V/Ld L t-' Owner or Tenant !LLB , M i 1J.if Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes [1 No D (Check Appropriate Box) Purpose of Building .,--A 1 ivi Utility Authorization No. Existing Service Amps / Volts Overhead g4 Undgrd D No.of Meters ® Q New e ice Amps / Volts Overhead❑ Undgrd D No.of Meters LJ1 IN er,N e of Feeders and Ampacity ` >j N Lyogtid and Nature( of Proposed Electrical Work: y� r4- 6 Ire-� l �'�"`'� Y a"'`` /ei in . V-1^-" ref/Ac--- e,1 !Sa I .i° el e_x_ Y`i 4.P 1 f^Ll e ( W t 1 L. D C�i✓r t/t� J s w W i . Completion of the following table may be waived by the Inspector of Wires. o F, No.of Total I N No?of ecessed Luminaires No.of Ceil.-Susp. (Paddle)Fans Transformers KVA Nb_:of...uminaire Outlets No.of Hot Tubs Generators KVA No of ruminaires SwimmingPool Above ❑ in m-d❑ Naott.eoryf E mneirgency Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices Total No.of Ranges No.of Air Cond. Ton No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No. of Waste Disposers Totals: Detection/Alerting Devices Space/Area HeatingKW Local ❑ Municipal ❑ Other No.of Dishwashers P Connection HeatingAppliances No.of Dryers PP KW Security Systems:*No.of Devices or Equivalent No.of Water No.of No.of Data Wiring Heaters KW 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: 7 0-00 (When required by municipal policy.) Work to Start: >/i`1" 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 in BOND 0 OTHER 0 (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. '/'/3 s LIC.NO.: FIRM NAME`_ �`t"„`� Signature lam'' LIC.NO.: S 3 (�'o D Licensee: /"\; � (If applicable,inter"exempt"in the license number line.) Bus.Tel.No.:-r°YZ� -7IS Li Address: -3Z `t 0-k Si liArvocil, MA O-LA,YS' 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 nor have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) 0 owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.