No preview available
HomeMy WebLinkAboutBLDE-19-000666 ✓ ,. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-000666 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked .."... [Rev.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:8/1/2018 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 lectrical wor described below. - /Q ^ Location(Street&Number) 216 WINSLOW GRAY RD rt.( 0 Owner or Tenant THOMPSON PATRICIA A Telephone No. Owner's Address LOMBARDO MARIA R,20 E JACQUELINE RD,WALTHAM, MA 02452 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 ❑ 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: Wiring for washer/dryer. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 1 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Ab0 In- ❑ No.of Emergency Lighting AI? grnd. Batters,Units No.of Receptacle Outlets 1 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 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No,of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts 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: Lawrence R Brown Licensee: Lawrence R Brown Signature LIC.NO.: 30708 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 LIMERICK CT,CENTERVILLE MA 026322713 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 Co momvealg.o`!t/aMac th on jibe Only��� J ._ Permit No. llJ Q/J� ✓ a 19 Apartment c7 =x � 1Jsl,artmsnt of-Pira Services =- �II7Occupancy and Fee Checked °-„'` ,,e BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4 'y / City or Town of: 1 enzo/11 the Inspector of Wires: By this application the undersigned gives notice of his or her Attention to perform the electrical work described below. Location(Street&Number)//i^� C/4 Telephone m/6, • /�//'/S/OGt) G /1 y Owner or Tenant �Z/ 0 11705 C / Telephone No. Owner's Address 2/ //MOa✓/ea (.J • y&'&W0N 1W t Is this permit in conjunction with a building permit? Yes Fa No ❑ (Check Appropriate Box) Purpose of Building 2/1t1/1/D,€/ /Pit) Utility Authorization No. Existing Service /0 el Amps /2.0 / New Service Amps L/p Volts Overhead EV- Undgrd❑ No.of Meters I Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 3 rU /0 U /4 Location and Nature of Proposed Electrical Work: 1,0,„e&-- /4/45/i 27,,✓ya=/ A? c res `tib, //t! C /TO.e r / • Completion of the following table may be waived by the Inspector of Wires. Q. No.of Recessed Luminaires No.of Cell-Susi).(Paddle)Fans No.of Total 'itTransformers KVA No.of Luminaire Outlets 9 No.of Hot Tubs Generators KVA No.of Luminaires / Swimming Pool Above Q In- ❑ No.of Emergency Lighting gird. grad. 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 Tta No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 CMunonneicipalction Q Other of Y d No.of Heating Appliances KW Security Systems:* DryersEr No.of Devices or Equivalent :5 2 '_' No.of Water KK, No.of No.of Data Wiring: 0 2 a Heaters ;;-'. i Signs Ballasts No.of Devices or E uivalent - No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications trim f-. _ No.of Devices or Equivalent -7,r_F <n"I _,; OTHER: 1— ";- - Attach additional detail if desired,or as required by the Inspector of Wires. S 1r LC ti Estimated Value of Electrical Work: 3'o V (When required by municipal policy.) U a:' `i; tl,,,r2,,,,-. Work to Start B-/- /if Inspections to be requested in accordance with MEC Rule 10,and upon completion. . ,:,,- a INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless ;,r -s the licensee provides proof of liability•insurance including"completed operation”coverage or its substantial equivalent. The (L`n 'e undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. _Cw -„ '. 'a E2 CHECK ONE: INSURANCE gp BOND 0 OTHER Q (Specify:) a I certify,under the pai and enalties Pipeclay,that the information on this application is true and complete. `i IL FIRM NAME: j../7/07 • ail/ 4-70.._7-fix./..401/ LIC.NO.: 30203r Licensee: / 41 e0/.L/Ai Signatur LIC.NO.: (If applicable,enter"ex pt"in the license umberlinef /� Bus.Tel.No.• 2 Address: ?,A Z./H'1672/Gt COei/C7— C•� v//7`` Alt.Tel.No.�'Slltc"...a?I'»d/ *PerltaLTer147;'s-57=61;security-workmquuts-Department-of-Public-Safety"S''LLicenset---Lic.-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 agent. Signature Telephone No. PERMIT FEE: S Email,