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HomeMy WebLinkAboutBlde-20-000009 Commonwealth of Official Use Only gE Massachusetts Permit No. BLDE-20-001381 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:9/11/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perto the electrical work described below. Location(Street&Number) 51 LOCUST ST i\hVe 1 Owner or Tenant Telephone No. Owner's Address ;— - - up . , . r,tr._. ,.1. . . -..- �..i, • ___ Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Washer/dryer in bedroom. Completion of the following table may be waived by the Inspector or 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- ❑ No.of Emergency Lighting grnd. grnd. _Battery Units No.of Receptacle Outlets 1 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/Alerting Devices No.of Dishwashers 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 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: DANIEL 0 WILKEY Licensee: Daniel 0 Wilkey Signature LIC.NO.: 32288 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 168 CENTER ST,SOUTH DENNIS MA 026603744 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: $50.00 dX 6e aiii f Commonwealth of///a.44achu etti • Official Use Only in �i c� Permit No. ' (�3 g t ' 1Jepartnent al girt sarvice5 BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 51* )4. I 1 19 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) 5 ) L Dc u5Y , S© Owner or Tenant 1 n r . 5 'Rr4 ii Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building()f z_ Mt\ —k E t )`(5 Utility tility Authorization No. Existing Serviced00 Amps /a0 ioNe, Volts Overhead Und f ❑ No.of Meters New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t 63(k3htt 4- ^� rx '1 K r 8Toor�. I�'ts'i�� V ��i-- Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell-Susp.(Paddle)Fans No.of Total Transformers I{VA _ No.of Lun inaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- No.of 1✓mergency Lighting — grnd. grnd. Battery Units No.of Receptacle Outlets l No.of Ott 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. Tom No.of Alerting Devices 1 No.of Waste Disposers Heat Pump!Number I Tons I KW No.of Self ontained Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal L0� Connection ❑ Omer No.of Dryers I Heating Appliances KVV Security Systems:* No.of Water No.of Devices or Eival qu ent Heaters KW No Signs No Data Wiring: 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: (p 0 (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 In. BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: � ,_.._ Signatur LIC.NO.: E (If applicable,enter"exempt"in the license rru er line.) Bus.Tel.No.: . Address: J *Per M.G.L. c. 147,s.57-61,securitywork requiresAlt.TeL No.: �� 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. I am the(check one)0 owner 0 owner's agent Owner/Agent I Signature Telephone No. I PERMIT FEE: $ I