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HomeMy WebLinkAboutE-18-953 Commonwealth ofOfficial Use Only (S\ Massachusetts Permit No. BLDE-18-000953 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked fRev.1/07j 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:8/18/2017 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice at his or her intention to pertorm the electrical work described below. Location(Street&Number) 58 PUTTING GREEN CIR Owner or Tenant BALLOU SUSAN C TR Telephone No. Owner's Address SUSAN C BALLOU REV TRUST,3 HILLCREST PARK RD,OLD GREENWICH,CT 06870 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 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Am pacify Location and Nature of Proposed Electrical Work: Wring for 2 bathrooms,2 closets,&hallway. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 2 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 8 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting _ grnd. grnd. Rattery Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones • No.of Switches 8 No.of Gas Burners No.of Detection and Initiating Devices , No.of Ranges No.of Air Cond. Total No.of Alerting Devices Toni No.of Waste Disposers Ileat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Tinting KW Local ❑ 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 Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total 11P Telecommunications Wiring: No.of Devices or Equivalent OTIIER: 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: MICHAEL S SOBY Licensee: MICHAEL S SOBY Signature LIC.NO.: 10097 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 Lake Dr,Orleans MA 02653 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/Agent Signature Telephone No. PERMIT FEE:$75.00 Zb.v- Pfu/r 7 _ P 2/(Weist e ikl 7(/31/8 t ` _ �_ lommoruuea of///auaehuedalfs Oeial Use Only �a art„:rife c�'7yY [� .Permit No. '_� P lYine Serviced - ' Occupancy and Fee Checked -_- BOARD OF FRE PREVENTION REGULATIONS . 1/07) (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT ININK ORTYPE ALL INFORM4T10A7 Date: /a /0 to City or Town of: YARMOUTH To the Inspector of Wires: . By this application the)mdersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 'l_aireo A - _ ♦ - / i Owner'orTenant � A ((a,2 Telephone No. Owner's Address Is this permit in conjunction with a buiidina emit? Yes No ❑ (Check Appropriate Boz) • Purpose of SmTdingeffThr ivy. )P f(',4 Utility Authorization No. Existing Service /tet Amps Pi i a Volts l Overhead Undgrd❑ Na.of Meters / New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity • Loea�ion and&&tare of ProposedyElectrical/Work: t, - ,E-/- a _, i i . _. .. .. * 2 C i,597-S . . [/ _ ..----..-. ...- . . - .. . Compl..'. of the following.table may be waived 6y the Inspector of Wirer. No.of Recessed LuminairesINo.of Ca-Soso.(Paddle)Fans No.of Total Transformers KVA No.of LuminaireOudets it !No.of Hot Tubs ILGenerators KVA ' No,of Luminaires 0 ISwfmm:ng Pool Above ❑ bi- INo.at)emergency Lighang crud. ernd. ❑ Battery Units No.of Receptacle Outlets Q • No.of Oil Burners FIRE ALARIYIS No.of Zones No.of Switches 67 No.of Gas Burners -No.of Detection and ' hitiatma Devices No.of Ranges No.of Air Cond. Tons Tons No.of Alerting Devices • Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers ISpace/Area Heating KW' I Municipal Connection 0 Other No.of Dryers (Heating Appliances KW Security Systems:* No.of WHater e tees KW INo. of No.of Data Wi Wiring: o.of g ccs or Equivalent Signs Ballast 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 Electical W-orrl02:7"-- (When required by municipal policy.) Work to Start: ilk /! TM/Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: NSURANCE$ BOND 0 OTHER 0 (Specify:) I certify, under the pion and penrrrAes f perjury,ttha`t the information on this application is true and complete. FIRM NAME: aretT t e `frocr rcle0e LIC.NO.: Licensee: // _ iia Signature ,rnt� l. LIC.NO.: l' =Y`� (If applicable,ent e/mp�t' m e kris. =miter I. e.) .4111.P-gra Address. , e...lri fir `���' �� y4- .0 Bus.Tel.No.:����[ca?( ' ` Alt.Tel.No.: ,j Per M.G.L.e. 147, s.57-61,security work requires Department of Public Safety"S"t c . . Lie.No. — OWNER'S INSURANCE WAIVER I am aware that the Licensee does nor have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. 1 am the(cheek one)0 owner 0 owner's agent t Owner/Agent j Signature Telephone No. I PERMIT FEE:$ l I