HomeMy WebLinkAboutBlde-19-005343 Commonwealth of Official Use Only
i.: Massachusetts PennitNo. BLDE-19-005343
Iti$7
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:3/26/2019
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her Intention to pertorm the electrical work described below.
Location(Street&Number) 595 ROUTE 6A
Owner or Tenant MERITUS RITHA Telephone No.
Owner's Address 595 ROUTE 6A,YARMOUTH PORT, MA 02675
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 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install split A/C system.
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 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 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 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 ❑ BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: KUNG-PO TANG
Licensee: Kung-Po Tang Signature LIC.NO.: 52286
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:518 COTUIT RD, MASHPEE MA 026492351 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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
t\QA 11li Ili re--
* _v i■-- _i/ Commonwealthof/ assac f ft • Official
, ci al Use On ly
Permit No . Q` �✓143
_ fit 1aParfm¢rf ofyins Services_
Occupan-..— BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/0 cy.a(l Fee Cnk
1 (leave blank)
-T I APPLICATION FOR=PERMIT TO PERFO
RM ELECTRICAL WORK
-
—:,� a i All work to be performed in accordance with the Massachusetts EIectrical Code(MEC),527 CMR 12.00
' L rPLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date• 3 Z (S-(.?
City or Town of: YARMOUTH
� x To the Inspector of Wires:
�' Z[ y this application the undersigned gives notice of his or her intention t perform electri work described below.
l_W Location (Street&Number) S 9 s- / L�A- -Ta-,�rrro,tir
,: fy �'
. Owner or Tenant j/L4 _ 5 Telephone - 75�6
Owner's Address c p
Is this permit in conjunction w th a build'// g permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building f'�la`deli t °� /
C 1 Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd gr ❑ No.of Meters
—
New Service Amps / Volts Overhead❑ Undgrd>;r ❑ No,of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: AA i yi _ „/I w7
Completion of the follcrwing table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeiL-Snsp.(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.oI Emergency Lighting -
prod. grnd. Battery Units
No. of Receptacle Outlets ( No.of Oil Burners FIRE ALARMS JNo.of Zones
No.of Detection and
No.of Switches No.of Gas Burners
Initiating Devices
Total
No.of Ranges No.of Air Cond. / Tons 3 No.of Alerting Devices
•
No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained
Totals: Detection/Alerting Devi
1 ces
No.of Dishwashers Space/Area HeatingKW Municipal
Local❑Connection ❑ '�
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
No. of o.N of
Heaters KW Wiring:
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: 3 —(� �i 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 rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [1 BOND ❑ OTHER ❑ (Specify:)
I certzfy, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME:
/� LIC.NO.:
Licensee: Cj,d�, ---/� Signature
(Ijapplicable,e r mp/t"in !:tern , )27
9�'li u�i z� ns.Tel.No.. �,
J Per M.G.L. C. 147,s.57-61,securitywork requires /�� 7 Alt.Tel.No.:
Department o`f Public Safety"S"License: Lic.No.
ct
— 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 ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: $ 0