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Home My WebLink AboutBLDE-23-001678 0— Commonwealth of Official Use Only 4iLAL Massachusetts Permit No. BLDE-23-001678 ......4...# BOARD OF FIRE PREVENTION REGULATIONS Occu pancy 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) City or Town of: YARMOUTH Date:To th Inspec022 toBy this application the undersigned gives notice of his or her intention to perform the electrical work described below.r of W fires: Location(Street&Number) 16 DANBURY ST Owner or Tenant JOSH GREENFIELD Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Existing Service Amps ead 0 Undgrd Utility Authorization No. New Service Volts Overh ❑ Amps VoltsNo.of Meters Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Miscellaneous work per attached. 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 No.of Luminaire Outlets Tr, s rme s Total No.of Hot Tubs KVA Generators / `� No.of Luminaires Swimming Pool Above ❑ In- rnd. rnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets Batter Units No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiatin. D•vices No.of Waste Disposers Number Tonsons Heat Pump No.of Alerting Devices Totals: ®No.of Self-Contained No.of Dishwashers --Detection/Alertin Devices Space/Area Heating KW Local ❑ Municipal 0 Other: No.of Dryers Heating Appliances Connection No.of Water KW Security Systems:* Heaters KW No.of No. if Devic•s or E i uivalent Si.ns No.of Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Device or E•uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E i uivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) 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: EDWARD M LYNCH Licensee: Edward M Lynch Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: 35609 Address:25 WIDGEON LN, WEST YARMOUTH MA 026733818 Bus.Tel.No.: 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 El owner's agent. Signature Telephone No. PERMIT FEE:$50.00 ..,GO5(4 f _� D SEP ri 4422 Q, , (Commonweakh al M/ aeaachueetfe Official Use{ Only/ BtiBi=t iivc�;' i''41' r"EtvT 2)spartmsnto/.}irs&raced Permit No. � l C�� ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' yv [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELEC RICA " WORK All work to be performed in accordance with the Massachusetts Electrical Code(I ) 5?Cps 12 Q�� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Gvv�(( City or Town of: YARMOUTH To the Inspect r of Wir • By this application the undersigned/ give oticepfhis or her tyste ion to perform the electrical work described below. Location(Street&Number)/ ! , ` f L G Owner or Tenant 0 Telephone No. Owner's Address i Is this permit in conjunction a bull g permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ''e /f(' Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and ture op1'rop/osed Ele ca Work c, / ('� ,‘,A) Completion of the of owing tabie m be waived bythe In ecto Zla s� r of Wires. No.of Recessed Luminaires No.of Cell:Sasp.(Paddle)Fans No.o Total Transformers KVA ch No.of Luminaire Outlets No.of Hot Tubs Generators KVA 4: No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting grnd. grad. ❑ Battery Units ;1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones -,- No.of SwitchesNo.of Detection and No.of Gas Burners III — Initiating Devices No.of Ranges No.o Air Cond. Tans) No.of Alerting Devices 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 Oth Connection ❑ � , No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent ' Heaters KW No.of No.of Data Wiring: - Signs Ballasts 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: 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 cov rage 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.: Licensee: iK , ! i C Signature:l J fi LIC.NO.: (If applicable, -me "e empt" ' the lice nytnbg,i'n ?, Address: (�'� //i Ili .4� Bus.Tel.No.:• ��g �`�' �� Alt.Tel.No.: *Per M.G.L.c. 47,s.57-61 security work requires Dcpartrn.i t of Public S:fe "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the censee 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. Owner/Agent Signature Telephone No. I PERMIT FEE:$ 60 I