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HomeMy WebLinkAboutBLDE-19-001638 • Commonwealth of Official Use Only 9Massachusetts Permit No. BLDE-19-001638 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.t/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:9/18/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 172 DIANE AVE Owner or Tenant MILLER JOHN K TRS Telephone No. Owner's Address MILLER JANE A TRS, 172 DIANE AVE,SOUTH YARMOUTH, MA 02664 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 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cei:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets • No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Ab ❑ In- ❑ No.of Emergency Lighting grnove d. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 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:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: RICH M MELVIN Licensee: Rich M Melvin Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIR,S YARMOUTH MA 026641207 Mt.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:$50.00 • a I©(7,11/8 l r-- c.t cy cc77 �Cr� Permit No. s a=nt 6 Jleparlment oi.ire Jeraiced OS.l G7 8— Occupancy and Fee Checked l� °N.ZS,�BOARD OF FIRE PREVENTION REGULATIONS [Rev 1/07] peaveblank) 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 MINK OR TYPEALL INFORMATION) Date: 4I13I1 Y " City or Town of: lar mo(kh To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Dtg.nt the1 St 4ufrotAin MR Oct&(o`f Owner or Tenant John +,IQnv non Telephone No.52521Y _na- Owner's Address 13(}111 E Is this permit in conjunction with a building permit? Yes ❑ No kr (Check Appropriate Box) Purpose of Building Utility Authorization No. V • t)l Existing Service_ Amps / Volts Overhead El Undgrd ElNo.of Meters __ ) New Service ___ Amps / Volts Overhead 9 Undgrd❑ No.of Meter's Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ilk- Stis1- M - '1ColI Condenser Com'Tenon o the ollowin:table in be waived I, the Ins.ectoro Wires. No.of Total 'Th--- • No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA ..JJJ--- No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above in. No.of Emergency Lighting �_ • No.of Luminaires SwimmingPaolgrnd. ❑ grad. ❑ Battery Units K>p No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS. No.of Zones No.of-Detection and No.of Switches No.of Gas Burners Initiating Devices _ Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin_Devi No.of Waste Disposers ces unici al No.of Dishwashers Space/Area Heating KW Local❑ Conne cion ❑ Other' ' ^ HeatingAppliances KW ecNo-Sur.ofDey ems:* V ' No.of Dryers PPNo.of Devices or Equivalent 60 No.of Watero.o No.of Data Wiring: Heaters KW Sins Ballasts No.of Devices or E•uivalent "E e ecommunications f iring: No.Hydromassage Bathtubs No,of Motors Tatal HP No.of Devices or Equivalent OTHER: . Attach additional detail ifdesired 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 0 OTHER 0 (Specify:) I certify,under �Itq the pains and penalties of perjury,that the in ormation on this application is true and complete. � FIRMNAN�J t~ tO It)SLow ' .,�ji- • e' ria e' ° c LIC.NO.: pIL Licensee: t( A alagF1fl/j /lt`tl..V()t) Signature 7 r � LIC.NO.a r$.n'I (If applicable,ent "e e .t"in the 'cense nu-her line) I Bus.Tel.No...98 3 Q`'/.7 Address: ; :/L.�aki U. Is Jsf.S r 0 ' a d Alt Tel.No.: *Per M.G.L.c.147,s.57-61,security war 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)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE: $ Signature . Telephone No. Sa\ .ac.. L.wr,omvrsrromcsre J ori woo mass macaw .. Depart -= De 1,_ . t.it P rraent oflndnstria[Accidents t I_;qp{_ ', Office of Investigations _;l'ir1=g• 600 Washington Street ` �Y Boston,MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers licant Information Please Print Le•ibl ae(Business/Organization/Individual): E.F'.anslow QIU.e, 1 b� 4 a al+ rsG. rler ddress: ; ;