Loading...
HomeMy WebLinkAboutBlde-20-000544 0 , Commonwealth of Official Use Only fillh Massachusetts Permit No. BLDE-20-000544 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•7/30/2019 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. Location(Street&Number) 50 LYMAN LN Owner or Tenant AIELLO DENNIS J Telephone No. Owner's Address AIELLO VIRGINIA MARIE,37 GOODALE ST,WEST BOYLSTON, MA 01583 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace weather head&SEU to meter. 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- CINo.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 Initiatine 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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 of perjury,that the information on this application is true and complete. FIRM NAME: Mark A Wermers Licensee: Mark A Wermers Signature LIC.NO.: 10563 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:29 LOCUST ST,S YARMOUTH MA 026645617 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 g;;L / ( Tc9 COMMoruusatth . , cc�' ole��//as w�achsfti ,. • Oflie�ialnUse Only _ 5-LH. , ___ ., / - . eparirnsnt of-. �7 irs Se vicsa Permit No. l��LJ� (� _ BOARD OF FIRE 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: City or Town of: YAR1VIOUTH e to�' g To the Inspector of Wires: By this application the pridersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number)50 ( lir ri(1 Ln , .`-)©v4 h Yd f i o 0.14-1 MA OTC n or Tenant rMpn n t7 .r. \ I ri{1 rn ei A .,Q JJ 0_ Telephone No. Owner's Address ?� 5© Lt Ldne . _moil Ycl✓rnou4_h . VW, Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /Cr) Amps /20 /2 y 0 Volts Overhead ❑ Undgrd ❑ No.of Meters New Service )no Amps 120 /2q(Volts Overhead❑ Una grd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ikeQldrk (i)Qdei hPr 1''led r) Cn >rvlLe en4(4 L.49tre\ rdhle Completion of the following table may be waived by the Inspector o >Pires. No.of Recessed Luminaires No.of Cetl�usp.(Paddle)Fans No.of LuminairesTotal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- No.of k..mergency lighting _rnd.. arnd. 0 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 Na.of Air Cond. Total . • Tons No.of Alerting Devices No.of Waste Disposers Heat Pump j Number I Tons !I KW No.of Self-Contained Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal 1- Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data R'iring Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent — Attach additional detail f desired or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: � p ry•) 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 1e,,K .4),e1/1,,,)o,r� Licensee: ^�\ LIC.NO.: ) C:/s 3 Signature V LIC.NO.: (If applicable,enter "erempt to Ulf license number line.) . Address: 2g Le)C 0'ir •' A-. ,N erne) tJe b Bus.TeL No.: _ �� __I *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety _ Alt-Tel.No.: — OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability Lic. No. insurance coverage normally S required by law. my signature below,I hereby waive this requirement I am the(check one ❑owner Owner/Agent owner's agent Signature Telephone No. _ ERMIT FEE: $ j