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HomeMy WebLinkAboutBLDE-18-006782 � [/ a © Commonwealth of Official Use Only Massachusetts Permit No. BLDE-18-006782 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07) 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:5/31/2018 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 electrical work described below. Location(Street&Number) 74 DESERT SANDS LN Owner or Tenant FAULKNER SAMUEL D Telephone No. Owner's Address FAULKNER DONNA L,74 DESERT SANDS LANE,YARMOUTH PORT,MA 02675 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel:kitchen,bath,living room,&bedroom. 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- ❑ No.of Emergency Lighting grnd. grnd. Flattery 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 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 ❑ 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 Jdesired,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: Richard J Rooney Licensee: Richard J Rooney Signature LIC.NO.: 27024 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 951,POCASSET MA 025590951 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 Q Telephone No. PERMIT FEE:$75.00 o€U �Ol I t7 / �L tAt$P • to/t7(re rt (' 'o( I(I eeriDe `firRt3 -5ewwi 21694162Sa) ISE X0' 2) ,i ji.7.p. J /� rly) . \� ammo. ama&of//lassacluwffi '.../... a'Ude Only 7B v m€k c cc77 Serviced Permit No. G g117i to = Im 2`)sparfinertf o`-1lre Jsralces \ • "1` [ Occupancy and Fee Checked 76 li fl BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07) ' (l bbd) — •APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code NEC).527 CMR 12.00 ry� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5-- 99 —(8 City or Town of: YARMOUTH To the Inspector of Wires: • :y this application the pndersigned give notice of his or her intention to perform the electrical work described below. 0 , i 'cation (Street&Number) 7 r j.) - Liu W w (+wnerorTeaant .S/<•m PoJ(aicC Telephone No. > N tr t wner's Address cS tn'(a rn w I this permit in conjuncts with a building permit? Yes �. No Iii c\i '0. .., 0 (Check Appropriate Box) V ¢ t0 .urpose of Building /fl$f GL Z Utility Authorization No. W L1L `= o :fisting Service /CXR Amps 10 1 0 Undgrd Fa_ No.of Meters ( / ZZ©Voltr Overhead It m .1 ew Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters umber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: pre kinalied j() Ani, fin-FLA J3eMwt Completion afthe following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.oCCeiL Ssp.(Paddle)Fanso.of Total Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Pool Swimming Abovend. ❑ d. 0 BaIn- No.ofttery UEmnitsergency Laghang aarn No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and ; Initiating Devices No.of Ranges Na of Air Cond Tuns) No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self Contained Totals: Detection/Alerting Devices CI No.of Dishwashers Space/Area Heating KW' LocalMunicipal Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* — v No.of WateroNo.of Devices or Equivalent Heaters KW No Sips BallastsNo.of No. Wiring: 0 No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - No of Devices or Equivalent * OTHER: a C r • �,/ Attach additional detail elesires(or as required by the Inspector of Wires. Estimated Value of Electrical Work: CI 7 (When required by municipal policy.) U Work to Start: 5--,g4—( Inspections to be requested in accordance with MEC Rule 10,and upon completion. 'C 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 c verage is in force,and has exhibited proof of sarne to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I cernfy,under the pains and penalties of perjury,that the information on this a plication is true and complete, • FIRM NAM LIC.NO.: ca Licensee: he/ t Signature it LIC. No•.: -y= rv?Z �, (Ijapplicable,a "comps"i he license tuber line.) • Bus.Tel.No.^• ,,,, Address. rci •par cThe DCI SZI MII 0g5.37AIL.Tel.No.: ¶caa 2 y �qqf j *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. act — OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverage normally O wn'dbg law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent j Signature Telephone No. I PERMIT FEE: $