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HomeMy WebLinkAboutBLDE-18-003422 Commonwealth of Official Use Only fMassachusetts Permit No. BLDE-18-003422 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ffiev.l/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 ALLINFORMATION) Date:12/11/2017 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) 44 GREEN WAY Owner or Tenant CHAKRAVARTI SATYA N Telephone No. Owner's Address CHAKRAVARTI ASHIMA B, 18 ASPEN RD, HOPEWELL JUNCTION, NY 12533-6233 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check r.1104: ) Purpose of Building Utility Authorization No. _ Existing Service Amps Volts Overhead 0 Undgrd 0 of-Me e�`'' New Service Amps Volts Overhead 0 Undgrd 0 1 k4. -SI& Number of Feeders and Ampacity /� �` Location and Nature of Proposed Electrical Work: Remodel N4O Completion of the following table may be wave e r�f Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of c / e� Transformers (7 rI . No.of Luminaire Outlets No.of Hot Tubs Generators A No.of Luminaires Swimming Pool Above 0 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 (feat 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MATTHEW D KLINE Licensee: MATTHEW D KLINE Signature LIC.NO.: 53620 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 Nehoiden St,Harwich Port MA undefined 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 Iy1LU tan l-ommor.w...TJc of t//ailae ct! O— . I se On ., Li • cc'7�� cc77 ((�� .Persil No. / ?/ apartmrnt:of 5:re Services - • BOARD OF FIRE FREVENTION REGULATIONS Occupacy and Fee Checked Rev. l/07] (leave blank) APPLICATION 'FOR:P€RMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLF.ASE PRINT 1 71 MIKOR TYPE ALL INFORMATION) Date: it J gi l7 City or Town of: YARMOUTH To the Inspector of Wires: • By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. • • Location(Street&Number) Jig Gr e t4e, Wool S Y Owner or Tenant Sat ki r • R�glht•rc'tJgrtS Telephone No.-_ Owner's Address I Q Pea, Ro „v o(I SI..1 Clio t A/7 Is this permit in conjunction with a handing permit? Yes X. No ❑ (Check Appropriate Box) Purpose of Building el t,i e..1),•,,e Utrlity Authorization No. Existing Service le o Amps J / Volts Overhead WX Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Amgacity --- • Location and Nature of Proposed ElectricalrWork: kt ted&tar G a I L 4rid n.alsttfi to e • % 3 Lits _ �w�t re .t:e� Completion of the following(table mcy be waved by the 1rsgecte r of Wires. No.of Recessed Luminaires No. of Cet1-Sasp.(Paddle)Fans Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA Na. of Luminaires Swim.azfng Pool Above ❑ la- No.or Lmergeacy krgnung - • srnd. end. (Ratters,Units No. of Receptacle Outlets No.of Oil Burners !PULE ALARMS kip. of Zones No. of Switches No.of Gas Burners INo. Initiating ectioDn and evices No.of Ranges Na of Air ConoL Total INo.of Alerting Devices - Tons • Heat Pump !Number I Tons 1 KW `No.of Sett-Contained Totals: Detection/Martina Devi No.of Waste Disposers ces No. oCDuhwashers • SgacelAreaHeating KW' Local Municipal a Connection ❑ OHtf No. of Dryers Heating Appliances KW Security S stes:' No. of Water No.of Dmevices or Equivalent Heaters KW INo' of No.of Data Wiring: Signs Ballasts Na.of Devices or Equivalent No. Hydromassage Bathtubs INo.of Motors Total HP Telecommunications Wiring: No.of Devices or Eottivalent OTHER Attach additional detail ifdetired,or as required by the Inspector of Wires. Estimated Value of Electrical Work 7)a 00 (When required by municipal policy.) SI Work to Start /2. /7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. ej 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 N enders geed 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:) r% I certify, under the pains and penalties ofperjury,that the information on this appfication is tree and complete. FIRM NAME: Q LIG NO.: Licensee: Al AM- K 1;sw_.. Signature ` LIC.NO.: 5.3 to 2.0 -I1 (If applicable, enter"aempr"in the licenseI�number fine.) Bus.TeL No:f2A 1 r ti Addresr. _7Z cf Oct( St l4ay.v r c-{, MA OZ LAIC' Alt TeL No.: "Per M.O.L.e. 147, s.57-61,security work requires Department of Public Safety"S"License: Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below,I hereby waive this requirement 1 am the(check one) 0 owner ❑owner's agent. , Owner/Agent J. Signature Telephone No. PERMIT FEE:$