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HomeMy WebLinkAboutBLDE-6-005761Commonwealth of Official Use Only Massachusetts Permit No. BLDE-16-005761 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: 4/25/2016 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to per orm e e ecrica work described below. Location (Street & Number) 361 GREAT ISLAND RD Owner or Tenant SWEAT MICHAEL D Telephone No. Owner's Address SWEAT RITA P, 91 SPOFFORD ST, GEORGETOWN, MA 01833 Is this permit in conjunction with a building permit? Yes ❑ No ❑ ( heck Appropriate Purpose of Building Utility Authorization N&'\21 38476 Existing Service 400 Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement of rusted meter socket 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 Battery 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 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number I Tons I KW No. of Self -Contained Detection/Alerting Devices 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 E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: o. of Devices or E uivalent 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRMNAME: NATES ELECTRIC INC Licensee: NASON F KING Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.: Address: 523 WHISTLEBERRY DR, MARSTONS MILLS MA 02648 Alt. Tel. No.: 7828 `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/Agent Signature Telephone No. (Zg� !6 -- PERMIT FEE: $50.00 z z LLJ U1 OF �- a I a 1po U �dz W �. n J_ :D CO '�'"\ �.ornmortvr¢iih o� �t�¢i3sa'httkr� 2 ry ..Uap¢r%ecrsf v��ire ,.�.aricey BOARD OF FIRE PREVENTION REGULATIONS f oracial Use. Only- iOcct.-pwicy and IF= Checked Rev. 1i7] ,i aye blank) _ APPLICATION AOR. 'PERMIT TO PERFORM ELECTRICAL WORK All work to be t tot n -.ti in a:conjancc v, - .:h the ivfzssachusem Elecn ice. Code WC), 527 CWR ] IN 'PLLA5,1 P?,IN.. I'V rVd; OR TYPE ALL 11vFORAbU IOM Date: LL City Or Town of: YARM j �J Thi ro rhe IrspQt:tor of Wires: 3y this armlicahon the ;uide.s:ped gives n otice of his or her intention to Perform the -electrical work described below. Location (Street & dumber)- Owner or Tenant M / c H 09 Telephone No. Owner's Address ,5o9mig Is this permit in conjunction with a building permit? '`;'es (Check Appropriate Boz) P'uFpase of Building ,�.5 r(�i��%C� _ Udlity Authorintion No. a f. d y7 6 Existing Service y_ea Amps -/,Ao / ya volts Oyerhead 7, Updbd [q`_ No, of meters 1 New Service Amps Volts Overhead t3ndgrd NO. of Meters Number of Feeders and ?.mpacity location and Nature of Proposed )Electrical Work-: �LANb A'11nP 1WJr ,_FR .SO Cm Iff- ---- -- - -- -- - Elf Ccra+for oft%se followin - - g table may be waived s . the In:•trec,ar nt'W;.� iNo. Of Recessed Luminaires INe. ofCei'1,-Srsp. (Paddle) Fails of Total- ota No, of Luminaire Out -jets No.Hot Transformers ransfor suers KVA --4T-- of Ttilir Geueratom KVA :Na, of Luminaires Swimming Pool Fool sae Cf IQ1- 'Salta mergeuey � ang rY Units ,'No. of Receptacle (iutistts ^ laic,. of Carl Burners FIRE AI.AmS N'. of Zues 'No. of Switches Na. of Gas Burners - _ n• a es ection iii -- - Initiatiltie Devices !No. of ranges TO No. of Air Co.nfLToes No. of Alerting Devices ['No. of :''ante Disposers heat JPump . nmberT ins �__ x 5�` a, a ei mnaiti v_ _ -- — otalst Detectiotn/Alertino Devices_ g`o`of Dishwashers ,Space/Area Heatiag K Local � ?�- U l j Other --""-----_ - _ -~~ Connectioe �No. of Dryers �o. Water— - Heating Appliances �y� eetirity stems:" No. of Devices or Equivalent of 1' KW Heaters ----x--- i'Vo. o ha, of i Sipes Ballasts , Data WirLn g: i .+ r---'- - �No, Hydreinassz;e Batht=ubs +a. of Devices lir Equivalent ; elecoaiiciuniratians miring No. of Motors Total HP No. of Det ices or E nivale-i 10THER- PSA r tZl ae9 rel a i W',e eo CGC'0,1-_ _5qr ©fscr/vv� 9� va9110T t troch ^Lf fitiOr7.` ue:oil 'i lex _e�� cr as required y the lr:spec or of iY ries. Estimated Vai,uc of Elzctrical �F'c+<r::: (V4'ben required by rnur:icipal policy..t Work to alit t:�rCO j ------ ? pe ctis tc be -e qucstca in accordance viith V --E(, P_Ulc t t0, add upon c o npitt,on. INS LR-A-NC"E i�OVF,RA€:sE: Unicss waived by the owner, no pernx?t for tate per ormaace of electrical work may issue unless c.,e ':icensee arc )•ides proof cf liabili Y insurance inchading "completed ovc,a sir." 00verege orits substar ial equivalent. e mdersig* ed certifies tb3t such Coverage is in force, and has exhibited proof of same to she permit issuing ofgce. Clfi _CK CJNI~: AI�>IIRAP.0 !� BO?ND ,01 OTHER � {Specify:) I cerdj.}, under the pilins and penalties arperjwy, that the informadon' vn -*his application it true and c, impleie. FIRM NAME: �9 i�S` � L� r'�,�`(c z1Z c LIC. NO--? 8� l.iet a+see: � S t7 Rl i� r,rJr Signature _dT , ^-J LIC. NO.: � f cthe licer_te number lrne. ) Ni,S tL} f3 fl F2 / Bus. Tel, !No_. aRn 79 At3dresr. .f"�3 w � � � ' flR .�r2 ® ----�3e;9' i *P Cs.l . c, t�!7, s. 57-61, sec+;nary work=e Lire, rJ cc ,b �------ Alt Tel. No.:_IS YID- �� epart rer, o> lic Safety "S" License: Lic. No. O W':NER'S FNSU.R_CgCE WAIVER: am aware that tic --- ----- f e :•;., nsee ao nit fL Ne d a is2biL'ty luau ince coverage n 32 tegwred by lase. By my signaturt below, 3 hereby waive ;.his rt-quirement I am Lhe , :hick oac owner '' a:maily c Owner/Agent � Li 9�vnet'; a ent Signature Telephone No. FE1Z�t T FFR; S i t? --- - _ _ --- - ?