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Home My WebLink AboutBLDE-22-002350 ol%ti Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002350 _ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Codc (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:10/25/2021 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. Location(Street&Number) 20 CAPT CROCKER RD Owner or Tenant Heidi Kiewel-Spencer Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No 0 (Ch ck a Box) Purpose of Building Utility Authorization No ' ,y%,,,, Existing Service Amps Volts Overhead 0 Undgrd 0 of New Service Amps Volts Overhead 0 Undgrd 0 o.,ltMe Number of Feeders and Ampacity ' e i Location and Nature of Proposed Electrical Work: Receptacle for water heater, add switch for light, &change fart' r r Completion of the following table may -w ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 No.of / •otal Transformers 72-.3 �RVA 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 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. �, PERMIT FEE: $50.00 a ) illiZ,S) NI) CO/1JL p`tw 6 , s r 9((3b-1Z I . . ECEIVED I---__-- Commonwealth of/// I OCT 22 7p1 C t M meochauft6 Official Use Only t:.. • _Y. ENT c� Permit No. l�2 Z_ S� v - --.--=I "1' 2 c7epartmrni al in Siruicae ' t -- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 1All 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: 9 1 I D 12) City or Town of: '/A 2 M V l!i.- 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) 2-0 CA PT i i.3 LQoc,lec2 'RD Owner or Tenant n L)a.Y t 1- ,t cm is""t£wtc-SGEtJ C4.2 Telephone No.(DS I -(402- /9s-3 v Owner's Address 2-o C .9T I N Gf10C_k_EAZ ?,O Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) J Purpose of Building RE-S 1 A>:r.JC E. Utility Authorization No. V Existing Service 1 OO Amps V )/ \'-IOVolts Overhead N Undgrd❑ No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd[1] No.of Meters .1' Number of Feeders and Ampacity Location and Nature of Proposed Electrical)Work: 0.-�J(h ci s- p,. '&t'' I� ,) y ,. l.l)/a kr ` a e t°A,r.. D epC.,S_6.)_...t .[e,--,4t a(.'1 eret Vl LiCompletion of the following table may be waived y the Inspector of of lres. No.of Total Cis No.of Recessed Luminaires No.of Ceil.Sesp.(Paddle)Fans Transformers KVA " Cl No.or Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting d`"'`�� grnd. grnd. Battery Units eoao-.. 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 I No.of Ranges No.of Air Cond. Taos No.of Alerting Devices No.of Waste Disposers Rat Pump Number Tons KW 'No.of Self-Contained P� Totals: Detection/Alertiun Devices No.of Dishwashers Space/Area Heating KW Local 0 MConneuniciction pal ❑Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsNofDevices or Equivalent y g No.of Devices Equivdent _ OTHER: Q 0 0 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: \\ 7a 'o0,--‘ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO OERAGE: 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 OTHER ❑ (Specify:) �'YILO\J(3U_ I certify,under the pains and penalties of pe cry,that the information on t is application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.' Address: Alt.TeL No.: *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 i surance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) owner ❑owner's agent. Owner/Agee O PERMIT FEE:$ Signature Telephone No.\PS l-k 21 lil