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HomeMy WebLinkAboutBLDE-19-006124 7- or utA'� A ° Commonwealth of Official Use Only . 'j\, Massachusetts Permit No. BLDE-19-006124 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:4/30/2019 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. 7 Location(Street&Number) 21 HEMEON DR 9— Z-3 - 420 Owner or Tenant MCLAUGHLIN STEPHEN B Telephone No. �t Owner's Address 28 SOUTH GATE ST, DEDHAM, MA 02026 ��N Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) ) Purpose of Building Utility Authorization NO,..., g 41` ‘41 Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service 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- 1:1No.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/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 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,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 o perjury,that the information on this application is true and complete. .fP .l O', FIRM NAME: RICH M MELVIN Licensee: Rich M Melvin Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: 21829 Address:8 REARDON CIR,S YARMOUTH MA 026641207 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 thecheck one Owner/Agent ( ) 0 owner 0 owner's agent. Signature Telephone No. I PERMIT FEE: $50.00 I Ly74 oic4(q ,-,,,.,,,_ ut cti ) 7 81-(4 o8_ ‘744 qtt_ efro1ict AA 49,04F !Lk 24 (( ci ormonwevCk oi 7/ao e A Of ficialUse Only ��c Permit No ;/� �_ � 14o �ptm-enc orre er iced _=f. Occupancy and Fee Checked___ BOARD OF FIRE PREVENTION REGULATIONS {Rev.1/071 (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (FLEA SE PRINT IN iNK OR T EALL INFORMATION) Date: 1 //g City or Town of: To the Inspector o f Wines: By this application the undersigned gives notice of his o her intention to perform the electrical work described below. I;ocation(Street&Number) t \- .on iJl Iye (k s t trnoytll OP.6 3 3 _____ Owner or Tenant C Telephone No.33 93 3539 0 Owner's Address (!0 60V 4- us r to k o a,I . Is this permit in conjunction with a building permit? Yes ^ No —(heck Appropriate Box) �y Purpose oz Building 'bto C% Utility Authorization No.0112,3212 Existing Service )f1� Amps 0/ 20 Volts Overhead[ Undgrd= No.of Meters t< New Service IOD Amps ?.til VoIts Overhead K Undgrd _ No.of Meters Number°of Feeders and Am• pacity Location and Nature of Proposed Electrical Work: (G O p ,fj y,£.e -0✓t�/l•CA Cotniletion o the ollowin:table may be waived by the Ins,ector o Wires. No.of Recessed Luminaires No.of Ceil.-Sus . Paddle Fans No. Total of KVA. (Paddle) Transformers No.of Luminaire Outlets No.of Hot Tubs Generators ISA No.of Luminaires Pool Above ❑ In- Swimming ❑:No.o£kmergencyLighting grnd. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones" nd • No.of Switches No.of Gas Burners No.of Detection Initiating Devices Total No,of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number _Tons !W__,•••• NofeoftiSoenfA-CornttinaignDe vicesTotals: No.of Dishwashers Space/Area HeatingLocal❑M ❑ other . KW p Connectzounicipaln * No.of Dryers HeatingAppliances KW Security ofsDevices No.of or Equivalent No.of Water KW No.of No.of Data Wiring: HeatersSins Ballasts No.of Devices or E I uivalent No.H dromassa e Bathtubs Telecommunications Wiring: y g No.of Motors Total HP No.of Devices or Equivalent OTHER: • Estimated Value of Electrical Work: Attach additional detail t desired,or as required by the Inspector of Wires. (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 a BOND ❑ OTHER ❑ (Specify:) c.D • Icertify,under the pains and penalties of perjury,that the information on this application is true and complete. L._p© FIRM NAME: ttOL,�tO (�G t C' t `_, • LIC.No,: j 5't=' M tfU(c� fii1,71i �,d r q::::. t_J 1 Licensee: �,� f) f l/�G �(i� Signature /� 6,1 - LIC.NO.:I2/5'..77,e (If applicable,emir"exempt"in the license number line.) r Bus.Tel.No.: O . � '7�{�� Address: 1 kg-4-ma)dir e SUItTI4 tII ,n,a'fi't�r Art y � AIt.TeI.No.: O *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 nom-idly required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. l PERMIT FEE:$ 51'V