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Home My WebLink AboutBLDE-23-000473 r Commonwealth of Official Use Only ':Atli 4)/ Massachusetts Permit No. BLDE-23-000473 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:7/29/2022 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) 51 BRAY FARM RD NORTH Owner or Tenant MICHAUD PETER A Telephone No. Owner's Address MICHAUD HOLLY T, 51 BRAY FARM RD NORTH,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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repair basement after flood. Completion of the following table may be waived by the Inspector of Wires. 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 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 No.of Switches 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 0 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 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: IAN B JACKSON Licensee: Ian B Jackson Signature LIC.NO.: 39860 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:273 MAIN ST, HARWICH MA 026452467 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: $75.00 (Zmati (I(1../77L ...---,. N-L 9/ ,/-3 � `` �'`�'`` ` / , ` ° . ' ' - � � ,� ` � u. ^ _ __ --_ __-~.____~_- -_ -RECEIVED JULCommonwealth o`Madearh.uddte Official Use Only ,.• _ i cc�� Jiro POcpancy ermit No. Z� `0 Li 7 3 1r.., fJ1 2epartmsnt of Jiro Seevncse LtN �_: 11.- and---"" ' ,or,Y----BOARD OF FIRE PREVENTION REGULATIONS Rev. 07 Fee Checked leave 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: City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to onm the electrical work described below. Location(Street&Number) j( 00 a•Y .}O,het 1)0Ara IVs.4,T#4}erf Owner or Tenant P, .tek Ill/r hg0t1 Telephone No. .56,,- ;vc- (/3 i 3 1, Owner's Address tj ( 173t; `1 FilAn (2c4a 01)c,2t"N) Is this permit In conjunction with a building permit? Yes ra No ❑ (Check Appropriate Box) Purpose of Building 7 GAS tn5 Utility Authorization No. Existing Service I 0 C Amps 12c. /Z'tc Volts Overhead[ Undgrd n No.of Meters ___I_ New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: i�QSr',neltTrit��t r �f n,s is�d (7c"15 1�C.q i,� + 1 — Completion of the followin&table nury be waived by the InT ector of Wires. Lit No.of Recessed Luminaires No.of Ceil.-Snap.(Paddle)Fans No.of Total Q� Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA r1 No.of Luminaires • Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. g_rnd. Battery Units 'i No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones v4. No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 1 i.i No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump(Number Tons KW *No.of Self-Contained Totals:1 .._....__..._.........._..._...._..__.._. Detection/Alertink Devices No.of Dishwashers Space/Area Heating KW Local❑ Co niectio 0 Other Cyonnection No.of Dryers Heating Appliances KW SecuritNoy Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromsaaage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 02 Lfc C (When required by municipal policy.) Work to Start: . Z.L 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: . ...A....-. t3 , SAtt�so Signature \�.,_ e_a_ LIC.NO.: E Sce8 C. (If applicable,enter"exempt"in the license number line.) Bus.Tel.No..Ca-.2?,O•-bBQE Address: 3 ill ,,r �{,� r; /lu� c <t rl! rF P= y� 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 signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 2S,1}0