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Home My WebLink AboutBLDE-22-002956 - Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-002956 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:11/21/2021 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. j }' Location(Street&Number) 52 ELDRIDGE RD Owner or Tenant Jo-Ellen Montbleau 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: Split A/C 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 Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons _ KW No.of Self-Contained Totals: Detection/Alerting 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 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 perjury,that the information on this application is true and complete. FIRM NAME: Dana K Otis Licensee: Dana K Otis Signature LIC.NO.: 27163 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 19C GIDDIAH HILL RD, ORLEANS MA 026534013 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 v�')) e/n�cj y/ �;f IRECEIVED1 Commonwealth Official Use Only . ',I V ]_ 8 202,IcQa�ac�a�a� lik ^x IB , . i': r ..L)ieparf`nnunf o f`�1„o S' Permit No. (� —Z�cj j 1� erviese ' BOA��`b FIRE;PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.[Rev. 1/07] (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: ,-/j':--/_.. - City or Town of: YARMOUTH To the Inspector of Wires 1 By this application the undersigned gives node of his or her intentj9n o perform the electrical work described below. Location(Street&Number)�` t5 j) t�r tr Owner or Tenant ` Owner's Address �- Lev) ( ,9-Li Telephone No. Is this permit in conjunction with a b Iding permit? Yes ❑ No Purpose of Building '.:jl :� R (Check Appropriate Box) ---- � �"' D'7r''. Utility Authorization No. Existing Servic ) Amps p 0 l` =,zd Volts Overhead Undgrd No.of Meters -___iL_ New Service Amps / Volts Overhead Number of Feeders and AmpacityAir El Undgrd �] No.of Meters Location and Nature of Proposed Electrical Work: Com letion o the followin table m be waived h the Ins ector o Wires. No.of Recessed Luminaires No.of Ceil:Snsii, . p (Paddle)Fans O.° ota !'a No.of Luminaire Outlets Transformers KVA ram, No.of Hot Tubs Generators KVA t` No.of Luminaires Swimming Pool 0Ve ❑ n- o.o mergency g m g rnd. nd. ❑ Batte Units g No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etec on an No.of Ranges Initiatin Devices No.of Air Cond. ota Tons No,of Alerting Devices eat ump um er ons o.o e - onta ne No.of Waste Disposers Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ un opal No.of Dryers Heating Appliances Kwecur ty Cstemstion ❑ other o.o a er o o No,of Devices or E uivalent Heaters ' ° ° Data Wiring: Si ns Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommumca ons ring: OTHER: No.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 Start: %" 2 (When required by municipal policy.) �/ 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 covem e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 2" BOND 0 OTHER 0 I certlfy,under the pains and penal' ojperjur,that th information on this application is true and complete FIRM NAME: / Licensee: 1 /' • LIC.NO.: 7�� , —'�� '�' Signature (If applicable,enter,erempy in ih�lie p / line.) LIC.NO.: i` f Address: .�r (_ , , r Bus.Tel.No.• �`- *Per M.G.L.c. 147,s.57-61,security work re ures De , _,s Alt.Tel.No. � y ��n OWNER'S INSURANCE WAIVER: I am aware that he Liiccen Licensee does not have he liability insurance c required by law. Bymysignatureherebyafety"S"License: Lic.No. Owner/Agent below,I waive this requirement. I am the(check one overage normally ale Signature � owner � owner's a-ent. Telephone No, PERMIT FEE:$