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Home My WebLink AboutBLDE-23-0002567 d Commonwealth of Official Use Only - tE Massachusetts Permit No. BLDE-23-002567 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:11/9/2022 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) 33 REFLECTION WAY Owner or Tenant HASKINS RICHARD W Telephone No. Owner's Address HASKINS SUSAN M, 9 OLD TAVERN LN, SUTTON, MA 01590 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: Remodel kitchen&bathroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 7 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 10 No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons _ KW No.of Self-Contained No.of Waste Disposers 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 Euuivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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: DAVID W SPRINGER Licensee: David W Springer Signature LIC.NO.: 21170 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:70 Bishops Ter, Hyannis MA 026012106 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: $75.00 (t I(067/ MR, 2ftci2 -k RECEIVED I('V 08 2022 nwaa[fh o`rr/aesac4iasaW Official Use Only -ice n_Y'•`-a. cc77 ��ii Permit No. (i C Zj 7 riT''.`, nt 4 in Jervicas �i�'`ING DEPARTME C -:•e• ':•a •'-- PREVENTION REGULATIONS Occupancy and Fee Checked k I • ` [Rev.1/07] ((cave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION( Date: j City or Town of: J YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. N Location(Street&Number) J j ;{rl-L V`":'1 • Owner or Tenant M( S �O$inS P SOB Z$ �e� • Owner's Address K Tele hone No 3 Is this permit in conjunction with a building permit? Yes [y/No \--} Building (7 ramose of t,�\\fN `_' ❑ (Check Appropriate Box) .•rJ Utility Authorization No. Iv Existing Servke I Oc Amps \'ZO/24C.Volta Overhead❑ Uod rd \ 8 0 No.of Meters C New Service i';U Amps '2U/7._%Volts Overhead Undgrd y ❑ g Q No.of Meters �Y ," Number of Feeders and Ampacity z jQU t Location and Nature of Proposed Electrical Work: ,rr v Completion of the following roble maw'be waived by the In Nor of Wires. 'ilUt No.of Recessed Luminaires No.of Ce1L Sos (Paddle) No.of spa ^! , p. Fans Total Transformers KVA 'Z; No.of Luminalre Outlets �-(""" No.of Hot Tubs Generators KVA 4 No.of Luminaires Swimming Pool Above 1-1❑ In- No.of Emergency Lighting No.of Receptacle Outlets grnd. grnd. Battery Units Lj No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No,of Detection and i' No.of Rao es `� Initiating Devices g No.of Air Cond. rota) Tons No.of Alerting Devices Heat Pump Number I Tons _ KW No.of Self-Contained No.of Waste DisposersTotals: I -._ _.. No.of Dishwasher Detection/Alertlny Devices Space/Area Heating KW Local I—,Municfpa No.of Drii.yers Connection Other• ry Heating Appliances K� Security Systems:* isro.o Heaters KW °•° o° No.of Devices or E uivalent Si ns Ballasts Do. Wiring: No.Aydromaaage Bathtubs No.of MotorsNo.of Devices or E uivalent Total HP e ecommun ca ors r ng 07•ffgg No.of Devices or E uivalent r COO. Attach additional derail if desired,or or required by the Inspector of Wires. Estimated Value of Electrical Work: w Work to Start:Estimated (When required by municipal policy.) Z Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of mine to the permit issuing office. CHECK ONE: INSURANCE BOND❑ OTHER I cerrljy,under the pains and (Specify') Penalties ojpeury,that the information on this application is true and completes FIRM NAME: S C t e C C L Licensee: V. co LIC.NO.;.i3— (If applicable,enter" Signature rsempr' the enumberli LIC.NO.:"Z,\\ ll A Address: �7J L5. J } '/ • Bus.Tel.No.• Q Per M.G.L.c.147,s.57-61,sechrity work requite epetnnant of Public Safety Alt.Tel.No., 13 \OWNER'S INSURANCE WAIVER: I am aware that the Licensee does no/ave the liability insurance coverage normally Lic.No. ---- required by law By my signature below,I herebywaive this requirement. I am the(check one Owner/Agent q owner Signature ■owner's a•ant. Telephone No.