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HomeMy WebLinkAboutblde-18-006126 ` Commonwealth of Official Use Onlyatt sior Permit No. BLDE-18-006126 Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:5/1/2018 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) 19 SEASIDE VILLAGE RD Owner or Tenant ALI LISA M TR Telephone No. Owner's Address LISA M ALI LIVING TRUST,3108 FRANKLIN ST, SAN FRANCISCO, CA 94123 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check opriate Box) Purpose of Building Utility Authorization No. y) .#. Existing Service Amps Volts Overhead ❑ Undgrd ❑ Ni. c : . r AmpsCI New Service Volts Overhead Undgrdo ; T� ,_j i Number of Feeders and Ampacity q/ ,/ 7 Location and Nature of Proposed Electrical Work: Install generator4rt./ ./2, O Completion of the following table may betiVii)r of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of1 Transformers No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 20 No.of Luminaires Swimming Pool Above 0 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 ❑ 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 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: MICHAEL TOTTEN Licensee: MICHAEL TOTTEN Signature LIC.NO.: 22421 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:228 STONEY CLIFF RD, CENTERVILLE MA 02632 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 ❑ owner's agent. Owner/Agent Signature Telephone No. 'PERMIT FEE: $50.00 I Nfill A_ 9/(cp/t8 i // Official Use Only __ _ ommonwea o a�dachu setts C 1_-----,------el�_ c� Permit No. P W-__` 1-- ; 2 epartment o/Jire�eruicee -r� � Occupancy and Fee Checked �i;,3 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) A • PLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MEC),527 CMR 12.00 (' EASE PRINT IN INK OR TYPE ALL INF RMATION) Date: S n l ( c -o l g City or Town of: SntA 6 C r'�pu*L To the Inspector of Wires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location(Street&Number) [O < e c s,A e U. a.3,e (nZd. Owner or Tenant L,i S 0 M; Telephone No.t..r 1S- 2)k U -[O 3 i Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Er (Check Appropriate Box) `J'urpose of Building kNA l A bL crjf Utility Authorization No. 1/49 Existin g Service ?pc. Amps l-Lp /? O Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Vo Location and Nature of Proposed Electrical Work: 2.-,03 0-el? ors� (,.a , tL 6 Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total `: Transformers KVAVA No.of Luminaire Outlets No.of Hot Tubs Generators 4.6 KVA 10 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting d grnd. grnd. Battery Units 4, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones CO No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 4 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection HeatingAppliances Security Systems:* No.of Dryers PP KW 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: c` 1 No.of Devices or Equivalent ` ) OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o Ele trical Work: 2-ct S0 (When required by municipal policy.) Work to Start: 5 ©, 1 ZOt g Inspections to be requested in accordance with MEC Rule 10,and upon completion. kAi 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 M undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE aBOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of erjury,that the information on this application is true and complete. 60 FIRM NAME: P ; r ,¢„( p� 'o C L C LIC.NO.: /yQLftf-B ro Licensee: ,M k clAc-�\ -73 e,Vl Signature ( ,e., LIC.NO.:2.2g2-1- /4 &..1 (If applicable,enter "exem lice rim nerrie n 1 us.Tel.No.. 0 Address: t� ` 9 // i (�4�Qh t t.Tel.No.: *Per M.G.L.c. 147,s.57-61,sedurity work requires Department of Public Sa ety"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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $