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Home My WebLink AboutBLDE-18-000822 Commonwealth of Official Use Only 0 1391 .r.U. Massachusetts Permit No. BLDE-18-000822 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:8/11/2017 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or tier intention to perform the electrical work described below. Location(Street&Number) 50 LONGFELLOW DR Owner or Tenant SEMINARA SUSAN A TR Telephone No. Owner's Address LONGFELLOW REALTY TRUST, 50 LONGFELLOW DR,YARMOUTH PORT, MA 02675 �' Is this permit in conjunction with a building permit? Yes 0 No 0 (Check App\1,'',,t a Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 f ;� New Service Amps Volts Overhead 0 Undgrd 0 ..id to Number of Feeders and Ampacity fy Location and Nature of Proposed Electrical Work: Wring for in ground pool. Off. Q �: Completion of the following table may be waived t aor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ElIn- CINo.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 Equivalent No.of Water KW No.of No.of Data Wiring: Heaters ,$jgns 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 ❑ 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 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: $85.00 itkCon-rzon..ru of Ma. rich.-,,-hca • Official Use Only c�� _` V , 2.p.,f..m.cnt of ,7-ire J Permit No. crrricxl BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked T. 1/07] (leave blank) • APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK • All work to be F.-I-formed in accordance with tlo Massachusetts Electrical Code NEC),527 Cl�il' 1 ZDD (PLEASE PRWT IN f\rK OR TYPE ALL INFORMATION) Date: - /0--/ 7 City or Town of: YA.RMOUTH To the Inspector of Wires: By this application the pndersiped Qives notice of his or her intention to perform the electrical work described below. Location (Street&Number) 57, �o,� re...,(I a w to.2 r 0 C y,/dz..y.�tg,y, 4' fk k Own er"or Tenant 5O3,q� S i *u 2l� S'oK Telephone No, z�z—9 e?2 Owner's Address Sri c „� _. u o' 0 2r tf✓ ._._ u tt,fr,-�•I- ' r't A Is thie permit in conjunction with a building permit? Yes ❑ No Purpose of Ettilam; ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead UndDQrd No.of Meters New Service Amps / Volts Overhead T Undgrd Ito. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f,v Gre,a ' root_ Completion of the followbzo!able may be wclved by the Inspector or hires. No.of Recessed Lu .nafre5 No. of Cell.-sup.(Paddle)Faris No.of Total n Transformers KVA No. of LLumTnaire Outlet No.Of Hot Tubs Generators li'VA No. of Luminaires $ mining Pool ;Above ❑ ld ❑ INn.on emergency Lighting Bat`..ry units No. of Receptacle OrrtLe*s INo. of Oil Burners IP'IZ.E ALARMS No. of Zones No. of Switches Na_ of Gas Ewers o.of Detection and — No. of Ranges Total $ Devices No of Air Conti Tons Ilan,of Alerting Devices No.of Waste Disposers Heat Pump INnmber 'Tons KW INn, ofu elf-Contained Totals: I Detecon/Alerting Devices No, of Dishwashers Space/Area Heating KW' Municipal Local D Connection ❑ other No. of Dryers Heating Appliances KW Security Systems;* No. of ricer No. of No,of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTAFR No.of Devices or E uivalent l; Attach additional detail tf desired or as required by the Inspector of Ti tres. Estimated Value of Electrical Work.... Work to Start (When required by municipal policy.) 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuingoffice. The CHECK ONE: D'SURANCE ❑ BOND ) I certify, render the pains and penalties of p ,n t 0ormafiofn on this appactition is true and FIRM NAME: complete Licensee: LIC NO.: Signature afaPPd�ble, enter "esempr 'in the license number line) LIC.NO.: Address Bus.Tel No.- Alt Per M G.L. c. ]47, s.57-61,security work requires D Alt Tel.No.: O'Per M_G. INSURANCE WAIVER I am a Department of Public Safety"S^ License: Lic.No. required by law, Byware that the Licensee does nor have the liability insurance coves o Omer/Age my signature below,I hereby waive this requirement I a the(check one ❑ owner ge nortnally l Signature are 1ISGi6t 4 G-�C� ❑owner's a eat TeIephoneNo.;�. "Z �i 'In PERMIT FEE: $