Loading...
HomeMy WebLinkAboutBlde-20-001753 Commonwealth of Official Use Only �E Massachusetts Permit No. BLDE-20-001753 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:10/1/2019 _ 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) 42 REFLECTION WAY Owner or Tenant DECELLES RICHARD C Telephone No. Owner's Address DECELLES CONSTANCE M, 33 DARTMOUTH ST, HOLYOKE, MA 01040-2053 Is this permit in conjunction with a building permit? Yes 0 No 0 (� A ©{LO-64 I9 Purpose of Building Utility Authorization N � Existing Service Amps Volts Overhead 0 Undgrd 0 ' New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement distribution panel. 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. 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 ❑ 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 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: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 21302 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 C i1 1o(7/ is * � � 4� �11�� K.Qt /W(/� � g- (omnronwsalih 4cc a sa4,,,eff4 • Official Use Only r� •/ 2) oarfrtsenf oi,�irs Services PermitNo. �� "t'=-'• Occupancy and Fee Checked `�, ,. BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07j (leave blank) . -- APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK :all work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1 z.00 (Y,�_-' (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: `�'` 3 r e I of \� ' City or Town of: YARMOUTH To the Inspector of Wires: ;--,� . By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. t� Location(Street&Number) ' k /-� C'�cc' 0- J • Owner or Tenant re,�il c.o_l }--S Telephone No. 3? '3e:) Owner's Address 5/ t tJ. Is this permit in conjunction with a building permit? Yes 0 N__o -� (Check Ap ropriate Box) Purpose of Building Utility3 CP I ( j Authorization No. Existing Service Amps / Volts Overhead D. Undgr'd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity e Location and Nature of Proposed Electrical Work: 4n,{)y 6--r, irih 13- Per ____PLV,--- �•/ • Completion of the follawbr&table may be waived oy the Inspector of FFires. ^- No.of Recessed Luminaires No.of Cell- KV Sasp.(Paddle)Fans To,of al � Transformers A 0- No.of Laminar Outer No.of Hot Tubs Generators KVA (._..— No.of Luminaires Sw_ming Pool Above ❑ in- ❑ No.of 1.mergency Lighting grnd. and. Battery Units No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS No.of Zones L.) No.of Switches No.of Gas Burners No.of Detection and Q/ - Initiating Devices Total ' ---J No.of Ranges No.of Air Cond. Tons No.of Alerting Devices c j.I No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Nems:* 2o.of Dishwashers Space/Area Heating KW- Local❑Cyostnncipp'on ❑ Ott No.of Dryers Heating Appliances KW 'Security ecNo of Devices or Equivalent s 3 No.of Wate ers KW No.of No.of Data Wiring:HeJ Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total AP Telecommunications Wiring: { No.of Devices or Equivalent d Attach additional detail if desires(or as required by the Inspector of Wires. Estimated Value of EIectrical Work. (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 . BOND 0 OTHER 0 (Specify:) e ---' I certify,under the pains and penalties ofpe jury,that the iretOrmation orkthis application is true and complete FIRM NAME: Wet i r L L . C`•Qt i Ccot/0 MUC LIC.NO.: ) t� Licensee: (,3C.t 4.et- k.4(I SYgnature Q.be j/ �/L LIC.NO.: --..‘.2 3.k,,._a /�` (If applicable,enter"exempt"in the lice a number line) Bus.Tel.No.:•J Address. V{��/0{l *6-e L. to _ 1�P CT ye.,rtti C+ LJ4' �� Alt.TeL No.:,"7Pc j3fn Z3 7, a "Per M:O. c. 14'7,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)❑owner Q owner's agent Owner/Agent i Signature Telephone No. 1 PERMIT FEE: $�d