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Home My WebLink AboutBLDE-23-003790 4 Commonwealth of Official Use Only iir ♦ Permit No. BLDE-23-003790 � * Massachusetts BOAR 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:1/12/2023 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) 12 ST ANDREWS WAY Owner or Tenant MARCY COHEN Telephone No. Owner's Address 12 ST ANDREWS WAY, SOUTH YARMOUTH, MA 02664 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: New bathroom. 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- I: No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating 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 p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g 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: Licensee: Joshua Jones Signature LIC.NO.: 23155 (f IPP �.applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:6 Pine Tree Circle,7 Liefs Lane,Sandwich MA 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. I PERMIT FEE: S75.00 I c 1(( g/23 re- Ck --(-- ,04;3 aa`' / }—Osffiijci�aall Use O+/n`llyyy]��®/ W/►i/NOINA/BRI NL O��P.SMr{yl{�g� r". ( fJ � / f.L/~ —— Permit No. ®.r---� -•--1 ,-_ —Cr c�t� E _= 11 ,_ .JJo artnrent oil irB erviceo N d,— a P Occupancy and Fee Checked -. N 1 Z BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) o a z A PPLICATION FOR a All work to be performedin PERMIT TO�PERFORMaccordance with the Msachusetts Electrical�ELode(IECTRICCA WORK C),527 CMR 12.00 uagi i EASE PRINT IN INK OR TYPE ALT INFORMATION) Date: cc m m City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention�t�o/perform the electrical work described below. Location(Street&Number) , ` 0(i if V✓ -, Way y Owner or Tenant ! : Telephone No. (5 )j°7 7-Cu d Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ° New Service Amps I Volts Overhead El Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 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 grad. ❑ 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 Total No.of AlertingDevices No.of Ranges No.of Air Cond. Tons No.of Waste Disposers Heatummp Number Tons _. KW_ No.of Self-Contained Totals: — Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW al❑ Municipal Connection ❑ Other Heating Appliances KW Security Systems:* No.of Dryers 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: c Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: PP 3, 0 CSC/, 0 C (When required by municipal policy.) Work to Start: I -i t -262, 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 ❑' 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: LIC.NO.: : 3 ►5 , -At Licensee: Signature . �✓ --yam LIC NO.:23 i 55 -4 (Ifapplicable, enter "exempt"p in the license number line.) -' Bus.Tel.No.: C/)7 7-C4(J) A r ? C?�`5(i' Alt.TeL No.: Address: � � � � r.�� !�,'t i� ]rf� *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,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. I Owner/Agent Telephone No. I PERMIT FEE: Signature