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Home My WebLink AboutBLDE-23-002473 _ Commonwealth of Official Use Only iti. , Massachusetts Permit No. BLDE-23-002473 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:11/6/2022 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) 478 HIGGINS CROWELL RD Owner or Tenant SLOMBA JONATHAN P Telephone No. Owner's Address 478 HIGGINS CROWELL RD,WEST YARMOUTH, MA 02673 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: Install temporary receptacles for repairs following house fire. 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 6 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 ❑ 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 Signs 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 perjuty,that the information on this application is true and complete. FIRM NAME: Kevin D Litchfield Licensee: Kevin D Litchfield Signature LIC.NO.: 12417 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:3 FULLER DR, PLYMOUTH MA 023601213 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 et(,C3 9 Jc olz3 c_24\ls . 2rt 1,44+1.-, A J.4 _ - OV 0 4 2022! REC-._EIVEC l // e/ �Qi % ILN /�� --...ti•--4s NG DEPARTME onr monwsa!!h o`///aeaacAuesife Official Use Only ( '� cc��s/oart`nunE o�.}i g n Ji{�rvicse Permit No. Z- i 7 ( �C/ ! REGULATIONS` BOARD OF FIRE PREVENTION REG Occupancy and Fee Checked Rev. 1/071 leave blank _ APPLICATION FOR PERMIT TO PERFORM ELECTRICALW All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527,CMR 12.00 rr ORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of: YA R M OUTH Date: /C�/y� 2 By this application the undersigned gives notice of his ention to perform the electriTo the Inspectcal or work ofdei s es: below. Location(Street&Number) 7 0 O::z :: T ^' „1 " `ai Telephone No. Is this permit In conjunction with a buildin ,e C �, C/`'ws_8Purpose of Building8 • permit. Yes 0 No [� (Check Appropriate Box) :/ - -e_. Existing Service� Amps / t.� / y Utility A orization No. Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity ❑ Undgrd [] No.of Meters —` Location •d Nature of Proposed v Electrical Work: 'j .. 0, .0 i t1��f`�� r' S L: % -� Completion o the ollowin: table m be waived b the Inspector o Wires. (,,Ir, No.of Recessed Luminaires No.of Cell.-Soap.(Paddle)Fans 'o•o ota CA No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA ,'l No.of Luminaires �F Swimming Pool ,rnd.e ❑ ,and ❑ 'o.o mergency g ng No. • of Receptacle Outlets c No.of 011 BurBurnerse Bane Units No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners `o.o 1 etec on an t No.of Ranges Initiatin: Devices No.of Alr Cond. ota No.of Waste Disposers 'eat 'amp `um er o s Tns No.of Alerting Devices Totals: ......_...._....._........................._. o.o e out a , No.of Dishwashers Space/Area Heating KW Detection/Alert , Devices Local 'un c pa No.of Dryers Heating Appliances Connection ❑ Other `o.o "a er KW ecu ty ystems: Heaters KW "o.o Si;us Ball No.of Devices or E uivalent asts Data Wiring: No.of Devices or E•uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommun : :ons " r ,g: OTHER: 4No.of Devices or E,uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Stan: (When required by municipal policy.) in INSURANCE COVERAGE: Unle sInspections to be wai waived by the owner,requested permit for the performancece with MEC lof electrical upon completion.aissu the'licensee provides proof of liabilityinng"completed undersigned certifies that such cove e is in force cand has exhibited prof of same to the permit ration"coverage or its substantial equivalent.o unless CHECK ONE; INSURANCE I certify,under the pains and penalties o 0 OTHER 0 (Specify:) issuing office. FIRM NAME: (perjury,that the lnfor»tation on this application is true and complete. Licensee: c..4 LIC.NO.:-----.- r Signature_ (lfapplicable, ter" empt"in the license num line.) LIC.NO.: ii Address: Li 11 �C = -! _ Per M.G.L.c. 147,s.57-61,security work requires Departrnent of Public Safety"S•License; Bus.Tel.No: ?fa y Alt.Tel.No.: .�3 z3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage required by law. Bymysignature below,I herebywaive this requirement. I am the(check one • Lic.No. Owner/Agent Bn q g normally Signature owner ■ owner's a:ent. Telephone No. PERMIT FEE:$