HomeMy WebLinkAboutBLDE-19-006389 i cir l Use Only
Commonwealth of
per- ,LDE " 39 t�
•E M0% assachusetts q
BOARD OF FIRE PREVENTION REGULATIONS 0,, ,tid Ft% ,
APPLICATION FOR PERMIT TO PERF( ;LE C:\L WORK
All work to be performed in accordance with til y 1,L,.1cIlusetts 00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D:;; `)19
City or Town of: YARMOUTH
By this application the undersigned gives notice of his or her intention to perform the,icrtncal work de, :I
Location(Street&Number) 168 ROUTE 6A
Owner or Tenant SILVA HOLLY E eleph;;,:,
Owner's Address 168 ROUTE 6A,YARMOUTH PORT, MA 02675
Is this permit in conjunction with a building permit? Yes ❑ (f n;c- l•rni,riate Box)
Purpose of Building • ntiNo.
Existing Service Amps Volts Overhead ; w deters
New Service Amps Volts Overhead ❑ 0 Na.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Remodel 2 bathrooms, add 2 hall 100 i 1 nor' i.
('nnipl i/h i' ,r, n waived inr the '''ire.c.
No.of Recessed Luminaires 2 No.of Ccil.-Susp.(Paddle) hi is �'° "'`'I
iTi m','
No.of Luminaire Outlets No.of Hot Tubs I Ge•n,'rn, •
No.of Luminaires Swimming Pool Above ❑ , 'icy Lighting
grnd. ,,rnd. i3atic t
No.of Receptacle Outlets 8 No.of Oil Burners I h1121 ,'•.. lS j No.of Zones
No.of Switches 8 No.of Gas Burners
,No u, 1;,• on :, 1i1
'!mfttn: ,u'cs
No.of Ranges No.of Air Cond. Tonal Not " 1 irvices
No.of Waste Disposers Heat Pump Number r- ions No or tt,iincd
Totals: ii)cic ,', tint: Devices
No.of Dishwashers Space/Area Heating K\1' ;Loc;,, 'i""Cipl ❑ Ort-'r:
:'n(cction
No.of Dryers Heating Appliances K\V 1Se1 o
:No. or ;univalent
No.of Water KW No.of No. ;if j 1)i t
Heaters Signs Ballasts 'No _ or l.lquivalent
No.Hydromassage Bathtubs No.of Motors 'hot>d 1IP Hine c ; r: iti-ms Wiring:
:o. : :; .. or :'quivalent
OTHER:
���— nn,• n'a.rreyuA'rrlhr,hc - 1ire.c.
Estimated Value of Electrical Work: (\`,'.:.r: nirr,l b, x,lir.
Work to start: Inspection to be requested in a,. vt tt. ;rr, . tt tIttrtl.Linn.
INSURANCE COVERAGE: Unless waived by the owner,no permit for ecrf:rrmance the licensee
provides proof of liability insurance including"completed operation"cove! ,_c c'r it.suhsrur : nt ' ._ er certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing c,llice.
CHECK ONE:INSURANCE 0 BOND 0 OTHER ❑ (Speci k.
I certify,under the pains and penalties of perjury,that the information on ii,ix application ;'chip-,•,,,
FIRM NAME: MICHAEL S SOBY
Licensee: MICHAEL S SOBY Signature li NO.: 10097
(If applicable,enter"exempt"in the license number line.) fei. ''o.:
Address:66 Lake Dr, Orleans MA 02653
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public S;tfcn "S" I_icens.
OWNER'S INSURANCE WAIVER:i am aware that the License does nrr .quircd by Iaw. i3t:
signature below,I hereby waive this requirement. I am the(check one) ❑ t'a ncr a_tt‘r,.
Owner/Agent
Signature Telephone No. /'; •?/ ':: S/00.00_ —___.
<'_ , 51tS. tctr
7� t
Commonwealth of Maddac ltd • Official Use Only
c 1_= ��1i el
0 = �i 1Jefu rlm¢nt o f ire Serviced Permit No. CA -� (Q-3 e 1
v, r i =` ' Occupancy and Fee Checked 11
`.s.' BOARD OF FIRE PREVENTION REGULATIONS LRev. 1/07]
(leave blank)
,� APPLICATION FOR,PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical C•. it C),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: YARMOUTH � `�- 9
To the aspect r of Wires:
(15 By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number) ./�A` �A
— Owner or Tenant �AJ/1 yam, ,917 f4 o.!!T Telephone No.
.,_ Owner's Address /
_Is this permit in conjunction with a building permit? Yes No
��� ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Serviced Amps /)Volts Overhead& Undgrd 0 No. of Meters
New Service Amps _ / Volts Overhead❑ Undgrd g ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature o roposed Electrical Work: Ga. H
'gam/-9/ �,/ // e�� '
�,A��1
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires v INo. of CeiL-Susp.(Paddle)Fans (No.of Total
I Transformers KVA
No.of Luminaire Outlets No.DI Hot Tubs Generators KVA
�j No.of Luminaires Swimming Pool Above Ei In- -No.of h.mergency Lighting
Prnd. arnd. � Battery Units
No. of Receptacle Outlets 4#A No. of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 15 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges N Total
o_ of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection1-1
s
No.of Dryers Heating Appliances _Security Systems:*
No.of Water No. of No.of Devices or Equivalent
Heaters KW No.of
Ballasts Data Wiring:
Siffns
No.of Devices or Equivalent -
No. Hydromassage Bathtubs No.of Motors Total HP (Telecommunications Wiring:
�� l No.of Devices orEquivalent
4�A. OTHER: _
Attach additional detail if desired or as required by the Inspector of Wires.
N Estimated Value of Electrical Work (When required by municipal policy.)
v Work to Start:
///f�S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO`'tRAGE: Unless waived by the owner,no permit for the performance
„ ithe 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 A BOND 0 OTHER ❑ (Specify:)
I certify, under the pains artd pertalltes of perfitry,that the information on this application is true and complete.`„. FIRM NAME:
�T� r"4 LIC.NO.:
/�'�Licensee:
Signature LIC.NO.:1 :72
(If applicable, en r "exempt"in the I. ns number 1. e.
Address: No.:
J Per M.G.L. c. 147,s_ 7-61,security work requires Department of Public Safe t.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage___
vera ee n—no_ -
S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner 0 owner's a lent.
7 Owner/Agent
Signature
Telephone No. PERMIT FEE: $