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Home My WebLink AboutBLDE-22-005260 \� Commonwealth of Official Use Only LA Massachusetts Permit No. BLDE-22 005260 �— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rRev.1/071 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:3/21/2022 City or Town of: YARMOUTH To the Inspector of Wires: N, By this application the undersigned gives nonce of his or her intention to perform the electrical work described below. Location(Street&Number) 499 ROUTE 6A ,// Owner or Tenant MELLINGER LINDA E Telephone`No. Owner's Address 88 OLD WILTON RD,MONT VERNON,NH 03057-1707 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 Nye)ey Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Entry foyer and closet �� \1./ Completion of thefollowing table may be waived by the Inspector of II'fre.r. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 5 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 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 4 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 ❑ 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 2v— 4)ef2,7,-(eft-Cr—GNAW call, co qt4,40 i RECEiVt • MAR 212022 _ _ tom ,ws¢rth ol 47a.44acku-6etts Official Use Only -Fp�CC=_ip!=s ) P r (-7,' tDLDING UEPARTMEN�er`,nit No. �„2 Do j-�Z 3,=_T - _ a o� n-a crvtcss--- — - — may'.- - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �"`;.`� , Rev. 1/073 It D ID I I r* A T t n a r r., r-�- r, .� . ... — — — (leave blank) — - - - .. B `a �Tii tv rl�ttc-uK[Yi tL.tLIKIUAL WORK All work to be performed in accordance with the MaSSachusetts Electrical Code 527 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To z -� _ � � _ o the Inspector of Wires. By this application the .cinde.irsizned aves notice of his or her intention to perform the electrical work described below. • Location (Street & Number) '/9 F 4 x Owner or Tenant /,,, a -- ,pGG /y‘:ei? Telephone No. Owner's Address - �� Is this permit in conjunction with a building permit? Yes RI No (Check Appropriate Box) Purpose of Building4/6//2,e/,/7-7A2- ,Utility Authorization No. Existing Service/ Amps I Volts Overhead Undgrd ❑ No. of Meters / New Service Amps / Volts Overhead ❑ Undgrd E No. of Meters Number of Feeders and Ampacity ? ffi9,/, Location and Nature of Proposed Electri Work: Ir-,0, 7 Ay fri.,---ye A / CCd.SI-7,51 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 I' Generators KVA No. of Luminaires 5 Swimming Pool Above ❑ In... "o. o mergency tong =rnd- et-nd. ❑ Battery Units No. of Receptacle Outlets e ma No. of Oil Burners ' FIRE ALARMS No. of Zo n es No. of Switches v/ No. of Gas Burners No. of Detection and ( Initiating Devices No. of Ranges fNcLofA.irConcL Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump l Number_fToasH KW No. of Self-Contained Totals: ( - Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW Local Q Municipal Connection ❑ Other No. of Dryers Heating Appliances KW _Security Sstems:* - -- No. of ater KW No. of No. of Devices or E.uivalent Heaters o. of Data Wiring: Signs Ballasts No. of Devices or E• uivalent No. Hydromassage Bathtubs No. of Motors Telecommunications Wiring: Total HP No. of Devices or E. uivalent OTHER: • �r Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Wor . Work to Start: (When required by municipal policy.) i Inspections to be requested in accordance with NC Rule l INSURANCE CAVE GE: Unless waived by the owner, no permit for the e 0, and upon completion. the licensee provides proof of liability insurance including "completed operation" of electrical work may issue unless undersigned certifies that such coverage is in force, and has exhibitedp coverage or its substantial equivalent, The proof of same to the permit issuing office. CHECK ONE: INSURANCE I certify, under the aims0 BOND 0 OTHER 0 (Specify:) P and penalties of perjury, that the information on this application is true and complete FIRM NAME: Licensee: ^� LIC. NO.H- (lfappiicabter4 . - -----________.. . gnature"exempt" in the license number line.) LIC. NO.: Address: - Bus. Tel. Iti'o.• J *Per M.G.L. c, 147, s. 57-61 , security work requires Department of Public Safe <<S„ Li Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability�e• Lic. No. required by law. By my signature below, I hereby waive this requirement I am the (check one insurance coverage normally 7 Owner/Agen� . ; ❑ owner ❑ owner's a ent Signature �U� 'C� Telephone No. 7O PERMIT FEE: S t