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Home My WebLink AboutBLDE-23-005463 ,. `\7i Commonwealth of Official Use Only (f( Massachusetts Permit No. BLDE-23-005463 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07i 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:4/3/2023 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) 358 ROUTE 6A Owner or Tenant JAMIE BOHLIN Telephone No. Owner's Address 358 ROUTE 6A, YARMOUTH PORT, MA 02675 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel bathroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 2 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 4 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 6 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 ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent 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 Eauivalent 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) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 L� tL 1 2 k • RECEIVED AR 312023 a4./M. ° !Oicial Use Only �' II i, cc77 Serviced Permit No. �` 3—50e ...'i!a, al al Jim Serviced ING DEPARTMENT Occupancy and Fee Checked 1 '=-- __ _ = —•-:PREVENTION REGULATIONS [Rev.1i071 (leave blank) 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Maasachuseus Electrical Code( EC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIONI Date: 3/2 /22 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).3‘S IZOIArk, (Q/ 1 r�,(' Owner or Tenant 3OJI4tc tNu(( „v.l,L1nl Tekphone No.�0�t 7 '�Qil'fJ ' Owner's Address k 12t'L„4•t,(a 4 10.A/IYl MA-414 Pt)a- Is this permit In conjunction with 'abu1ld(1ng permit? Yes No ❑..-k (Check Appropriate Box) Purpose of Building �L&u'"f l f(Arl ,f Utility Authorization No. Existing Service 2-0 6 Amps (2o/ 4-1 Volta Overhead Vf Undgrd❑ No.of Meters a- ,l New Service P)A Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty �" 4 Location and Nature of Proposed Electrical Work: VYtI e,vi j Fats ro's'vv I Completion of the(ollowittg,table m be waived by the lnsperror of Wires. No.of Recessed Lamivaira �1 No.of Cell:Sup.(Paddle)Fans No.of TVA (i W Tnmformen KVA No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ gin, ❑ No.a EmergencyUitnLighting arhd. Izrod. Battery Units No.of Receptacle Outlets 4 No.of Oil Burners FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners 'No.of DetectionDevices �O Initiating No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices No.of WasteDis Disposers Heat Pump Number Toss KW No.of Self-Contained pose Totals: ... -____.. Detection/Alertin Devices No.of Dishwasher Space/Area Heating KW Local 0 Municoanectlom herSecuriipil ❑Other C No.of Dryers Heating Appliances KW No. f bevices or Equivalent 'Ho.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of evices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP 'TelecommunicationsN.ofDeor qui al Y g No.of Devices Equivalent _ OTHER: Attach additional detail if desired.or as required by the Inspector of Wires. Estimated Value Electrical Word 16.'0 D•6D (When required by municipal policy.) Work to Start: ArAinspections 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 11 BOND 0 OTHER❑(Specify:) I certify,under the pains and penalties of perjsuy,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: rlfapplicable.enter-exempt'.in the license number line.) Bus.Tel.No.. Ad dress: 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 insurance coverage normally required by law. By my signal re belo ,w,I hereby waive this requirement. I am the(check one) owner ❑owner's agent. Owner/A I Slgnatu / Telephone No.(I F4 3q iQ(?tirl PERbfIT FEE:$ •t 1 rAl • • • • ti . i