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HomeMy WebLinkAboutBLDE-19-3452 '4u :© Commonwealth of Official Use Only or tit Massachusetts Permit No. BLDE 19 003452 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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 ALL INFORMATION) Date:12/6/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorpi the cl�ctnca(work described below. Location(Street&Number) 40 CROSBY ST EXT p- st,T LI �`ItaGi\7-� Owner or Tenant ) Telephone No. Owner's Address 40 CROSBY ST EXT,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: Install RV receptacle,garage lighting&heat,pole light switch, &rear motion light. J Completion of the following table maybe waived by the Intoe of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of oral Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators No.of Luminaires Swimming Pool Above o In- o 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 Imtiatine Devices (KVA 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 ❑ 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: PAUL J VIOLETTE Licensee: Paul J Violette Signature LIC.NO.: 20858 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:18 ANCHOR DR, FORESTDALE MA 026441822 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"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 ((0 (1 V �- - COmmonwfalth o`///assac its Official Use Onl ' Permit No. « q _ f S-7.-- . 'z-4/ ,!..-;,; ,/ \} 11,1--- i 3 i > Th•Parfmont of Jin Services Occupancy and Fee Checked 3Z) fr U BOARD OF FIRE PREVENTION REGULATIONS (Rev. I/07] (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYP,EALL INFORMATION) Date: 11 J30 I!V City or Town of: '( r yrs O t.t,4-k. 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) 4 0 Gros b, Si- E X Owner or Tenant A• 1--c..IC e_ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building I F4-M • Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters TelcaI- pd Du+IGS Gut. L t1/+f•^f f l}ta ;� o G L i S tJ. i co kat ® ion and Nature of Proposed Electrical Work: Q eG,,- Th.O l e n L 4. i cw j I Completion of the folowin&table may be waived by the Inspector of Wires. o. �t Recessed Luminaires No.of Cei.-Sus .(Paddle)Fans No.of Total ( o pTransformers KVA Crts w No.!�f Luminaire Outlets No.of Hot Tubs Generators KVA u No rf Luminaires Swimmin Pool Above ❑ In- ❑ No.of Emergency Lighting lY . g grnd. grnd. Battery Units Roil Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones oNo.of Switches No.of Gas Burners No. Initiating and Initiatinggon Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons— KW, No.of Self-Contained P Totals: _.- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Locai 0 Municipal ❑ other No.of Dryers Heating Appliances KW Securi No. f Devi es or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunNo.of Devic sons 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: 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 0 BOND ❑ OTHER 0 (Specify:) I certify,under theipainsland penalties of perjury,that the information on this application is true and complete. \/ FIRM NAME: i o l e. 4- 4- e E I tG t-r t c_ LLC LIC.NO.: a D S-f v4 Licensee: Pa CA t .T- V i o te, E c-c...._ Signature fad J- " - LIC.NO.: (If applicable,enter"exempt"In the license number line�. Bus.Tel.No: Sag-3 G y-SS 7S %l Address: ISP nc.ino✓ l)r.uc Fortsi)ca4 t'r14- oa6 'i'1 Alt.Tel.No.: *Per M.G.L.c. 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 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.