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Home My WebLink AboutBLDE-21-004315 oF . Commonwealth of Official Use Only j Massachusetts Permit No. BLDE-21-004315 ,.--' 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:2/1/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 10 KEARSARGE RD Owner or Tenant COUTURE THOMAS C Telephone No. Owner's Address COUTURE CAROLYN L,42 PLEASANT STREET, SOUTHAMPTON, MA 01073 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check rate Box) Purpose of Building Utility Authorization No � �/ Existing Service Amps Volts Overhead 0 Undgrd o."i i e •rr. New Service Amps Volts Overhead 0 Undgrd 0 • •• Alai" Number of Feeders and Ampacity .t Ap f• ' Location and Nature of Proposed Electrical Work: Wiring for sun room&porch.Wire split A/C. O 8/;Z> Completion of the following table may be w. ' e, . ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of VA Transformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- ElNo.of Emergency Lighting grnd. tired• Battery Units No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. 1 Total 2 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertinc 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 Data Wiring: Heaters Siens 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: 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 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 CG . l�onuwonreeaa"(a o`c�r77r/meachwe a Permit No. `�ZI Onlyy� l s Qw �5eparimeni e�Jire. emits �V1 j Occupancyand Fee Checked J BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/07j (leave blank) cr 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 TYPR ALL INFORM4TION) Date: A -2 '—a City or Town of:B ///�✓/1?() l To the Inspector of Wires: By this application the undersi gives tice of his or her intention to perform the electrical work described below. : Location(Street&Number)/(, 1 e I j /A) Owner or Tenant /t'/Jt Get i i)Jf e- Cl Telephone No. Owner's Address S/9:17 e--. ,�/ Is this permit in conjunction with a building permit? Yes p� No ❑ (Cheek Appropriate Box) Purpose of Building_5/t``p /WO), /71007t°, Utility Authorization No. Existing Service fir Afnps ///5 /226)Volts Overhead❑ Undgrd a No.of Meters / New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters _ • Number of Feeders and Ampadty k G (-0 "'6 Location and Nature of Proposed Electrical Work: 4djed2 4,..,,,., S 4,'1 )Q/G t i,4 .v Completion of the following table maybe waived 0the Inspector of Wires. lb No.of Recessed Luminaires No.of Cell.-Snap.(Paddle)Fans Tf TotalTr Transformers KVA p No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' No.of Luminaires SwimmingPool Above ❑ grnd. ❑ No.cry Units Lighting grod. Battery Units No.of Receptacle Outlets to No.of Oil Burners FIRE ALARMS No.of Zones T No.of Switches No.of Gas Burners No.of Detection and FInitiating Devices TotaI U No.of Ranges No.of Air Cond. J Tonsl of cp No.of Alerting Devices No.of Waste Dlsposen HeatT Totals: Numr Tons._KW,-.,., De�No.oction/Alerti 1 Devices No.of Dishwashers Space/Area Heating KW Loal❑Conuectlon ❑Oair 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.Hydromassage Bathtubs No.of Motors Total HP Tel No.of o of Devievkatlo sr W trft Nxs or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspectorof Wires. Estimated Value of Electrical Work: /-2 (When required by municipal policy.) Work to Start:/.;2 ,�/ 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 covTge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) I certify,under the and pmmdties of�that the information on this application is true and complete. FIRM NAME: �q fr Z-0c-d 'G9-,-1• LIC.NO.: Licensee: 2 c <) C9Q1-/S Signature ran,1, �, LIC.NO.:27// —/_.- (If applicable,enter"exempt"in gre liven nuit er line. Bus.Tel.No..77 -; ;)-/',/60 Address: /l/L (-`�)d/i .C)/ vY/LL / 4(/.F'.4if ��. Q�6.�3 Alt.TeL No.: °Per M.G.L.c.147,s.57-61,security work requir Department of'ublioeSafety"S"License: 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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. 1 PERMIT FEE:$