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HomeMy WebLinkAboutBLDE-19-000611 F Commonwealth of Official Use Only 'S Massachusetts Permit No. BLDE-19-000611 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Meg.I/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:7/31/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. Location(Street&Number) 169 CRANBERRY LN Owner or Tenant BERGSTROM IRENE M Telephone No. Owner's Address C/O HARNEY DONNA, 104 POND ST,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: Installation of security system. 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. 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 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 El 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 El 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: Kelly A Keane Licensee: Kelly A Keane Signature LIC.NO.: 1195 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:125 HILLSIDE DR,CENTERVILLE MA 026321740 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$45.00 ]�ejai 9/.3�/he tcp, 74e • I Aasmnw .a(7ama,y Official Use Only Permit No. Lln-c'` i / '3. Thepariaanto{Jiro&MICas . • Occupancy and Fee Checked 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 C),5 7 CMR 12.00 (PLEASE PRINT ININK ORTIP ALLINFORMA??0I� Date: 7,713 e City or Town of: Vah'1MO- /� To the Inspector of Wires: By this application the undersigned ves notice of his or her intention to perform the electrical work described below. Location(Street&Number) //9Crzim l /,yl , Ownerbr Tenant S, y Aa Telephone No. Owner's Address / f r*w.c - 4gsva..s Is this permit in conjunction with a building permit? Yes 0 Noo (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 Workrc' eg/./44.i, f eLAt_cc at Completion of thafollowinttable may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of CelLSasp.(Paddle)Fans Transformers KVA . No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency lighting grad. grnd. Battery Units ` 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 No.of Ranges No.of Air Cond. Ton Tons g No.of Alerting Devices ers Heat Pump Number Tons KW 'No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertlngpevices No.of Dishwashers Space/Area Heating KW Local0 Muonnecniciptional 0 Other C HeatingAppliances Security Systems:* No.of Dryers pp No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent _ OTHER: . Attach additional detail if desirec4 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 the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: ASSCC/ATEo ALA2in Cy$'rctpi5 ..r,YC LIC.NO.: Licensee: !{EDGY A. K&AAf6 Signature'--III/ , �(a&, k'td. LIC.NO:: IIg5C (If applicable,enter"exempt"/n the license number line.) Bus.TeL No.• SOS'7751c3WL. Address: /0Yr7 f"RLrr7oc i254I Hy,9Nt/t ori! Alt.Tel.No.:goo- 5 a-3339 . *Per M.G.L.c. 147,s.57-61,security work requires Department of Pub c afety"S"License: 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)0 owner 0 owner's agent. Owner/Agent PERMIT FEE: $ - Signature Telephone No.