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Home My WebLink AboutBLDE-23-005828 ak Commonwealth of Official Use Only ��, Massachusetts Permit No. BLDE-23-005828 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:4/20/2023 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) 96 HELMSMAN DR Owner or Tenant EDITH STANTON Telephone No. Owner's Address 96 HELMSMAN DRIVE,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriath Bole) /7/ Purpose of Building Utility Authorization No. 'Existing Service Amps Volts Overhead ❑ Undgrd 0 Mo.of Meters '''� / New Service Amps Volts Overhead 0 Undgrd 0 1qe.of Meters '!, Number of Feeders and Ampacity ? --s.Location and Nature of Proposed Electrical Work: Install receptacle&fan/light in basement bathroom. w� 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 1 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine 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 Siens 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:) /3 — �( _ g Z 30 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. [ l 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 Zuc-tt 6( ( (23 c � Cr ,) el( 173 Ili (# utr1t ) RECEIVED APR 19 Q803t o wealth of Massachusetts �'eal use .l�y Q Permit No.: � cep ment of Fire Services Occupancy and Fee Checked: 445 P BT PREVENTION REGULATIONS [Rev.1/2023] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C1s4R 12.00 City or Town of: YARMOUTH Date: 41/9(1-1 To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below. Location(Street&Number): G //Etr-isrio../ /)R. Unit No.: Owner or Tenant: EO/74 „.77AtvTd/i Email: /3R/ArJ jai BSA-t-t C• CO Ai Owner's Address: 9 is /1E44 rM sW Do. .6.0.mOti73eO 27 M . Phone No.: 7l 3-lO/- �i t7o Is this permit in conjunction with a building permit?(((heck appropriate box)Yes[K No❑Permit No.: Purpose of Building: "ES Drive Utility Authorization No.: Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters: New Service: Amps /_Volts Overhead❑ Underground 0 No.of Meters: , Description of Proposed Electrical Installation: /NSrr4ec (/) 4FcZ at,Tt.E7— ^r o C/„) E7esiikt,S7 CAN/L/�iKr 4) W Ew /30, Rc.1t.0+ /N EX/ST. /34.3fMe7✓/ Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices: Swimming Pool:In-Grad.Cl Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1 El Level 2 0 Level 3 0 Rating: OTHER: Attach additional detail if desired,or gs.required by the Inspector of Wires. Estimated Value of Electrical Work: 2V 0 (When required by municipal policy) Date Work to Start: 6/r IZ? Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: A-1 0 or C-1 0 L1C.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: LIC.No.: Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: Address: Email: Telephone No.: I certi,under the pains and penalties of perjury,that the information on this application Is true and complete. Licensee: Print Name: Cell.No.: INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability 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❑ BOND❑ OTHER❑ Specify: 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)Owner a Owner's agent❑ Owner/Agent: p Et)t77/ CjitA/ 'taN Tel.No.: 7/3--i4/-SZ3 Signature: (GCtctYLOrbrt-t L. Email.: /3R[4- i @ /SSA'[.LC.COM