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Home My WebLink AboutBLDE-23-000118 Commonwealth of Official Use Only . ,I Massachusetts Permit No. BLDE-23-000118 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/N INK OR TYPE ALL INFORMATION) Date:7/8/2022 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) 1 FLORENCE LN Owner or Tenant BROWN MICHAEL D Telephone No. Owner's Address BROWN DEBORAH L,29 WILSHIRE CIR, DRACUT, MA 01826 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: Bath room, living room,&sitting area. 4 Completion of the following table may be waived by the Inspector of Wires. A 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 3 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 e", No.of Switches No.of Gas Burners No.of Detection and 11 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 Totals: Detection/Alerting 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 perjury,that the information on this application is true and complete. FIRM NAME: MICHAEL YOUNG Licensee: MICHAEL YOUNG Signature LIC.NO.: 22314 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 156 CAPES TRL,WEST BARNSTABLE MA 02668 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: $75.00 WIllcrQ-1-0 IRECEIVEi1 i JUU 07 2p2 o r[tIa o`!r/aeeaciuwafle Official Use Only Pe mt No.i 23 a((Cjum:AN°DEPAi €Nt titof�iiy Serviced V. BOARD OF FIRE PREVENTION REGULATIONS [Rev. / cy and Fee Checked ) (leave blank) `" APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M 527 R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �S City or Town of: YARM O UTH To the Ins�ecto7 f Wires: ® By this application the undersigned gives'?gives,ti a of his or her intention to perform the electric work described below. Location(Street&Number) J f-4. ,4,c_e LN QOwner or Tenant�t'Lt,A�2 . ,,awN Telephone No. fjj� y jO /3(o a 1 Owner's Address cq C,../iLs-t/a e^il [ ' ' 6def L)7- ,4- Ia this permit in conjunction with a building permit?, ' Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building C�,r Le /)P r/7D" Utility Authorization No. Existing Service.020o Amps (e.94/„„)yG Volts Overhead Undgrd❑ No.of Meters L New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty / Location and Nature of Proposed Electrical Work: ,Ny /_,la. p�� ton/ L(Li, � . cr. 4 vcCompletion of thefollowin table m be waived by the In for of Wires. (!s No .of Recessed Luminairessom No,ofsec r.,/ Cell.-Snsp.(Paddle)Fans Total Transformers KVA nNo.of Luminaire Outlets No.of Hot Tubs Generators KVA d" No.of Luminaires Swimming Pool Above In- ❑ No.of Emergency Lighting and. grad. Battery Units No,of Receptacle Outlets No.of Oil Burners ., FIRE ALARMS INo.of Zones No.of Switches No.of Gas BurnersNo.of Detection and l t t — Initiating Devices No.of Ranges No.of Mr Cond. To No.of Alerting Devices No.of Waste Disposers Heat Pump Number_Tons KW No.of Self-Contained Totals: _ I �� Detection/AlertlngDevtcee No.of Dishwashers Space/Area Heating KW Local❑Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent HeatersK' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: Work to Start: (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 coy s in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0(Specify:) I certify,under th- 'ins and prfna es ofperfury,that th,nformagon on this application is true and complete FIRM NAME: (/t-„/(- / ✓L / LIC.NO.:2_,L /Lj Licensee: Aso:', ce, !i (Ifapplicable,enter"exe, t"'.th Uc /Y'�" or LIC,NO.: ‘- Address: ' li /-,� _ Bus.Tel.No.; >7 c7%,D °Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: AIL 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 a_•eat. Owner/Agent Signature Telephone No._________ PERMIT FEE:$ 73--.00 GzO.3