HomeMy WebLinkAboutBlde-20-000375 _atiAcr. Commonwealth of Official Use Only
Permit No. BLDE-20-000375
- Massachusetts
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:7/22/2019
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.
Location(Street&Number) 56 CHANDLER GRAY RD
Owner or Tenant SULLIVAN RAYMOND L JR Telephone No.
Owner's Address SULLIVAN CONSTANCE M, 13 GLENNA DR, SMITHFIELD, RI 02917-3541
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: Replace panel,furnace,&add on NC.
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- ❑ 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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alertine 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 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 of perjury,that the information on this application is true and complete.
FIRM NAME: Joseph W Silva
Licensee: Joseph W Silva Signature LIC.NO.: 9147
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:30 BOURNE HAY RD, SANDWICH MA 025632761 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
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Permit No. �✓
and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07]ry blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance w the Massachusetts Electrical Code(MEC),527 Chili 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: '7/ 7 —t ?
City or Town of: y/ 11-Xrri-' 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-(o N l.)(,Lit— G
Owner or Tenant CO....x4.11 � S J(,.`I;IA Id Telephone No.
Owner's Address .Sp-rl
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building S 1kP1cc, ris.fri t(.J Utility Authorization No. •
.4 Existing Service Amps- - I -___Volts Overhead❑ Undgrd❑— No.ofMeters
v
JNew Service Amps / Volts Overhead ElUndgrd ElNo.of Meters
C Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: w/te_i_ /3-D D -=a 4.1 NC, 14) £KS/S7 /
V Completion ofthefollawi�table may be waived by the Inspector of Wires.
No.of Total
IP No.of Recessed Luminaires No.of Cam.-Susp.(Paddle)Fans Transformers KVA
QNo.of Luminaire Outlets No.of Hot Tubs Generators KVA
1•- Above In- No.of Emergency Lighting
No.of Luminaires Swimming Pool ❑ ❑
erred. grad. , Battery units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
y No.of Detection and
No.of Switches No.of Gas Burners Initiate Devices
jNo.of Ranges No.of Air Cond. Tons No.of Alerting Devices
VJ 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❑C 0 Other
No.of Dryers Heating Appliances KW Seceta of or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equilent
Wiring.
•Ne. s of Motors Total HP No.of Devices or Telecommunications 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:l!/7 1/ 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 cov a is in force,and has exhibited proof ofsame to the permit issuing offs
CHECK ONE: INSURANCE (BOND 0 OTHER 0 (Specify:) e d h ri err-'c 4-'44, 87 7
I cestify,under tk!pins and penalties of perjury,that the information on this application Is true and complete.
FIRM NAME: S i i--V& r_t.,ECi -.t L. LIC.NO.:/ 9/V 7
Licensee:`]t p1 .W Sr t41A- „Tit__ Signature LIC.NO.: E Z 16 c/9 _
(Ifapplicable enter"exempt"in the license number line.) Bus.Tel.No:i511 -V Z�-cl d 5 -
Address: 3a L0v Ut< IV4Lf goS9-4Du/«-4, /7W U 2.5 3 Alt.Tel.No.:gO 5'-3 6 q- 93 i /
*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)q owner. 01 owner's agent.
Owner/Agent '
Signature Telephone No. I PERBIT FEE-$
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