HomeMy WebLinkAboutBLDE-18-001090 •
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Of p Commonwealth of OfficialUseOnly
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Massachusetts Permit No. BLDE-18-001090
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.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:8/25/2017
City or Town of: YARMOUTH To the Inspector of Wirer
By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below.
Location(Street&Number) 55 MAUSHOPS PATH
Owner or Tenant BRUNS GARY JOSEPH Telephone No.
Owner's Address 55 MAUSHOPS PATH,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No 0 (Cox)
Purpose of Building Utility Authorization N
Existing Service 100 Amps 120/22( Volts Overhead 0 Undgrd ❑
New Service Amps Volts Overhead ❑ Undgrd 0
Number of Feeders and Ampacity 0
/C,
Location and Nature of Proposed Electrical Work: Repair:Kitchen update,add washer dryer,change panel ``//JJVV'///�
0
Completion of the following table may b e r of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
TransformerKVA
No.of Luminaire Outlets No.of Hot Tubs Generators /a) KVA
No.of Luminaires Swimming Pool K bove ❑ Ign- o No.of Emergency Lighting lII l
end. end. Battery Units /14,/
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 6 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges 1 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 1 Space/Area Heating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers 1 Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Siens 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,oras required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: 08/23/2017 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 thatsuch��i
coverage is in force,and has exhibited proof of same to the permit issuing office. T
CHECK ONE:INSURANCE 0 BOND ❑ OTHER 0 (Specify:) i g r—J/
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Jason D Smith
Licensee: Jason D Smith Signature LIC.NO.: 52070
(Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:22 ELMORE ST,LYNN MA 019021630 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 0 owner's agent.
Owner/Agent •
Signature Telephone No. PERMIT FEE:$75.00
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