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Home My WebLink AboutBLDE-23-003755 OLD # \(?) Commonwealth of Official Use Only E` Massachusetts Permit No. BLDE-23-003755 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:1/10/2023 13C.- be-- ,43 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. ) S '7 Location(Street&Number) 125 ROUTE 6A Owner or Tenant UROLOGY ASSOCIATES of C.C. Telephone No. Owner's Address 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 ❑ 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: Install UFER ground. 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. Ton l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: John R Mangold Licensee: John R Mangold Signature LIC.NO.: 20311 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:9 SPINNAKER DR, MASHPEE MA 026493655 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 ag Owner/Agent Signature Telephone No. 141•/80 PERMIT FEE: $80.00 1 if Z. (( k3kz.. ( IC :S1) X t) (.___ _.0e0_ 3L-Z. (20 .. A ) e�c�; , Z 1,40ANN ;31ik, (4, 4.019 QtSca (rccS/v1Au - i(/ re.13a '/cu) it/ /Lt' Gi40.11 A-c--Revs.a (t(64.2.3 _ Rec �c� D" tc RECEIVED [ JAN 10 Commonwealth a`rr/aimed...eelfe Official Use Only ��.I�" c7 n Permit No. (Z3",/ [c� BU LDING DEP letarlmant al ire-gamiest By - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.1/07J (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK v All work to be perfoen d in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 a (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: p I Z U L 3 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 k described/ below. Location(Street&Number) Zs / l t0 t0 14 T Owner or Tenant U(1,10 J y S Jl(7 f t Ol U 1 cfp CO Telephone No, So g 7 f j(11-/S'pts 0 Owner's Address J 2 S 0/6� �f i;, `,f It i j Li w I I Is this permit in conjunction with a building permit? Yes ®, No ❑ (Check Appropriate Box) Purpose of Building C a An f✓i t('CI of Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of MetersNew Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampaclty Location and Nature of Proposed. E al Work: K,61A} Otte 0( W u, f o1 qO F€K_ 9CO•In 4 100f Completion of the followinqble may be waived by the Inspector of Wires. Lit No.of Recessed Luminaires No.of Ce1L-Soap.(Paddle)Fans o.°f 7 otal • Transformers VA C. No.of Luminaie Outlets No.of Hot Tubs Generators KVA �k- No.of Luminaires Swimmingpool Above In- No.of Emergency Lighhng crod. ❑ crnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones nt of Detection and = No.of Switches No.of Gea Burners No,IeitlaNng Devices II.? No.of Ranges No.of Air Cond. Toss No.of Alerting Devices No otWnteDispoxn Hat Pump Number Tons_._ KW_ No.of Self-Contained - Totals: -.. ._ . ��" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Locai Municipal 0 Connection 0 Other No.of Dryers Heating Appliances Key Security Systems:. No.of WaterNo.of Devices or Equivalent Herten K' ' 'No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Aydromaauge Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: U Fr_F._ ((.,,xa Attach additional detail if desired,or as required by the Inspector of Wires Estimated Value of E tricot Work: I/VU, • (When required by municipal policy.) Work to Start:I I • 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE 0 RAGE: 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 cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0(Specify:) I certify,under th,a pains and penalties of perjury,that che Information on this application is true and complex FIRM NAME: CAA(, M A 03 d l el e l ea()C 4.1-...0 LIC.NO.: -la Licensee: Jr) c, d A PI 4 s ten Signature —tZjj,i1) LIC.NO.: -Doi (If applicable enssjp"exempt"in the licR•*e number line.) j$us.Tel.No.. Address:"1 4 is intOt I-ce 1,)ct`t-e ^ blAtislei rv, -e Wlli O24,9 (Alt. 4l Per M.G.L.c.147,s.57-61,security work requires Department of Publie Safety"S"License: Lie.No.• Oj� 78 ~(�D 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 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ C,k4 103 'retkcit 6auwit3 Rat c -t- 2 474 Od