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Home My WebLink AboutBLDE-15-002765a Commonwealth of Official Use Only Massachusetts Permit No. BLDE-15-002765 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev.l /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: 11 /18/2014 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice ot his or her intention o pe orm e e ec rwa work described below. Location (Street & Number) Owner or Tenant _ Owner's Address 220 SOUTH ST i eiepnone iNo. RMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install CO detector and gas valve 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- ❑ rnd. grnd. No. of Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatine Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons I KW No. of Self -Contained 1 Detection/Alertina Devices I I I No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Estimated Value of Electrical Work: Work to start: Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: MICHAEL S SOBY Licensee: MICHAEL S SOBY Signature LIC. NO.: 10097 (Ifopplicable, enter 'exempt" in the license number line.) Bus. Tel. No.: Address: 37 CLIFF POND RD, BREWSTER MA 02631 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) ❑ owner ❑ owner's agent. Owner/AQent Signature Telephone No. PERMIT FEE: $80.00 (ccommonwea& of ///a6ac"ffiF;7 Ofrltci/al Use Only /— . CJaParfinenf o��ira �crtrrced BOARD OF FIRE PREVENTION REGULATIONS d Fee Checked . U1leave blank) S APPLICATION FOR- PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527 CMR 12.D0 `N (PLEASE PRINT IN INK OR TYPE ALL INFORM4TI019 Date: City or Town of: ARMOUTH To the Inspector of Wires: By this application the Ymdersigned gives notice o his or her in ntion to perform the electrical work described below. Location (Street &Number)14 d Owner or Tenant 1 Telephone No. Owner's Address a� ��/�� aa� Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Boz) Purpose of Building L =� Utility Authorization No. Existing Service Amps / Volts Overhead ❑. Undgrd ❑ No, of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work t` .DQ �_-� .'►r t n._ - -- - - v Ca n of the ollowinQ No. of Cef1.-Susp. (Paddle) Fans table m be waived the I erlor oj�r�, No. of Tot No. of Recessed Luminaires No. of Hot Tubs (Swimming pool Above In- Transformers KVA Generators KVA o. o me gency a rag �Batterp No. of Luminaire Outlets No. of Luminaires grnd . erred. No. of OR Burners No. of Gas Burners Units F RE ALARMS No. of Zones o. of Detection and No, of Receptacle Outlets No. of Switches No. of Ranges No. of Air Cond. Ti Toots Initiating Devices No, of Alerting Devices No. of Waste Disposers Heat Pump umber Tons . o Nof elf-Coataine Tom: Detection/ -Alerting Devices No. of Dishwashers S ace/Area Heating KW' p g L0� Municipal 0 Other Connection No. of Dryers No. Heating Appliances KW Security Systems:* No. of Devices or Equivalent of ater Heaters KW No. No. o o. of Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs INo. of Motors Total HP Telecommunications Wiring: OTHER: or .� Attach additional detail if desired; or as required by the Inspector of wires. Estimated Value of Electrical Worlonms (When required by municipal policy.) Work to Start � 1/Aj to be requested in accordance with I'AEC 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: INSURANCEAV BOND ❑ OTHER ❑ (Specify:) I cerft; fy, tinder the p 'n r and penadides of perjury, that the information on this application is true and complete - FIRM NAME: LIC. NO.: Licensee: Signature LTC. NO.: (If applicable. enter "ez t " ' i 1' e.) Bu Tel.No: Address: Tel.No. :MW,45 *Per M.G.L. c. 147 s. 57-61, sec!IIurity work requires Department of Public Safety `S" �c e: Lic. No. WV ONER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage n— o ally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent. k Owner/Agent l Signature Telephone No. PERMIT FEE: S