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HomeMy WebLinkAboutBLDE-18-1529Commonwealth of OfftdalUse Only ®Massachusetts PetmitNo. BLDE-18-001529 �— 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 TYPEALL INFORMATION) Date: 9/18/2017 CityorTownof: YARMOUTH To the Inspector of Wires. By this application the undersigned gives notice of his or her intention to per orm the electrical work described below. Location (Street & Number) 5 CARRIAGE LN Owner or Tenant SANDY SIDE CORP Telephone No. Owner's Address P 0 BOX 525, YARMOUTH PORT, MA 02675 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 exterior lighting and change devices in carriage house. Completion ofthe following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp.(Paddle) Fans No. of Total Tntisforme KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. No. of Emergency Lighting 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. Total No. of Alerting Devices No. of Waste Disposers Heat Pumpber tal. • Numns T KW No. of Self -Contained Detection/AlertingDetection/Alerting Deviceq No. of Dishwashers Space/Area Heating KW Local ❑ Municipaln 13Other: no, tin No. of Dryers Heating Appliances KW Slecurity Systems:" o. of I)cilces or n I n No. of Water KW Heaters No. of No. of i n Ballasts Data Wiring: N I n No. Hydromassage Bathtubs No. of Motor Total HP Telecommunications Wiring: f Devices i len OTHER: Attach additional detail )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 ofperjury, that the Information on this application Is true and complete. FIRM NAME: Lance A Macenemey Licensee: Lance A Macenemev Signature enter NO.: 11149 Bus. Tel. No.: Address: 126A MID TECH DR, W YARMOUTH MA 026732560 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. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 N,e f- _ l�ornmoruueaUh o` ///aesac�rcteffs Oficial Use Ord Permit No. 2 C - -- �(.JeParimeni a�..iirs Jaraics! Occupancy and Fee Checked •L BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] leave blank J APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEY), 527C R1t2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 10� T 1 • rt City or Town of: fMQtA To the Inspector of Wires: By this application the undersigned gives notice of his or her 'mention to perform the electrical work described below. y� Location (Street & Number)Q tea _3 Owner or Tenant m ( elephone Na. Owner's Address fY1 Is this permit in conjunction with a building permit? Yes ❑ o ❑ (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: Aciti yo) ct-'e'rt 6C U �(..d'�Q - (Ar—v; Completion ofthe followinz table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above Eln- ❑ Swimming Pool rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Tong No. of Alerting Devices No. of Waste Disposers eatump Totals: Num_ er ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ municipalEl Other Connection No. of Dryers Heating Appliances KW echo of Devi es or Equivalent No. of Water, No.—Of o. o Data Wiring: Heaters Signs Ballasts No. of Devices or E uivallent No. Hydromassage Bathtubs No. of Motors Total HP a No. 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: Inspections 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 al ns and penallies of perjury, that the information on this application is true and complete. FIRMNAME: 1�uliv-r IOM LTC. NO.: A Ili q Licensee: nQ e C C (nZJ Signature S_ LIC. Nq (Ifapplicah/gg, en ter"exempt"i,�yelice numbe h ) �� fts Tel. No. j 30 Address: (c�'A m1C�Iyrl t InY%- (mA Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. 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 ❑ owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No.