Loading...
HomeMy WebLinkAboutBLDE-20-000706 or 4. Commonwealth of Official Use Only Permit No. BLDE-20-000706 E 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:8/6/2019 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) 5 COCHESET PATH Owner or Tenant PICARELLI ROBERT F Telephone No. Owner's Address PICARELLI MARION E,56 POND VIEW CT, OSSINING, NY 10562-2656 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: Replace smoke detectors, replace devices, &install arc fault C/B's. 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 i 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 ❑ 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: THOMAS P SULLIVAN Licensee: Thomas P Sullivan Signature LIC.NO.: 18182 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:71 WAQUOIT RD,COTUIT MA 026353517 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 Signat e Telephone No. PERMIT FEE: $75.00 oe_tA- 0(-7Iti M qiu4L etie61 C ommoruusaLtls o �j __�/ ///aacilt • Official Use Only - C C z -070c ' Permit No. 1 -_�__ aparlm¢ni o ,,.Serviced � r f ' Occr�panry and Fee Checked `�G " BOARD OF FIRE PREVENTION REGULATIONS ev. l/0 (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 �P E PRINT IN INK OR TYPE ALL INFORMATION Date: g. — C -/9 1 e, w City or Town of: YARMOUTH To the Inspector of Wires: erVa? $ .s application the pndersigned gives notice of his or her intention to perform the electrical work described below. 0 > r ton (Street&Number) C EJ C h-e.t e l_ co !�1 W J ner or Tenant�1,bp j f may ) EA Y e 2.L j Telephone No. (.) V s 1p er's Address Lu U < I45 permit in conjunction with a building permit? g Yes No 0 (Check Appropriate Box) I cc -•---j m ose of Building eI I c4efl 1 2ot , Utility Authorization No. + waiting Service Amps / Volts Overhead ❑. Undgrd 0 No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters �\ Number of Feeders and Ampacity ��` cation and Nature of Prpposed Electrical Work: �,�p(R..Lt. S 0 ke afar ►ii S o ee1 to (ttvks IZ Fetwill h �e t5 wt Cc re F� � 1�- r!'.>, r t c-i 4-S ' Completion of the following table may be waived by the Inspector of Wires. v No.of Recessed Luminaires No.of CeI7.-Susp.(Paddle)Fans No.of Total Transformers KVA _ S " K No. of Luminaire Outlets No.of Hot Tubs Generators VA - No.of Luminaires Swimming Pool Above Ia- No.of Emergency Lighting ernd.. Elgrnd. ❑ Battery Units '-__..... No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1No.of Zones No.of Switches No.of Gas Burners No.of Detection and —I Initiating Devices Total � No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: _Detection/Alerting Devices r`' No.of Dishwashers Space/Area HeatingKW' Muaicipal Local❑Connection ❑ Other ` No.of Dryers Heating Appliances KVV Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW Signs No.of Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent 2 OTHER: Attach additional detail if desired or as required by the Inspector of Wires. I Estimated Value of Electrical Work: 'S /n© (When required by municipal policy.) Work to Start: !�� /S 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 i s unl the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equi alente Thess ^ undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. - 11 CHECK ONE: INSURANCE [--BOND ❑ OTHER ❑ (Specify:) Ilk I certify, under the a' penalties of perjury,nirct theigformation on this application is true and complete FIRM NA . + v.////��`J 4r- f- e LIC.NO.: / Licen : j ti s Signatu LIC.NO.: (If applicable.enter"exempt"in the license number line.) / _� \ • . Address. "7 ‘ t,v �(�X r2 nl�� fits Bus.Tel.No.: J `Per M.G.L. c. 147,s.57-61, ecuri work requiresDep Alt.Tel.No.: ty t 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 ❑owner's a ent. Owner/Agent 1 Signature Telephone No. PERMIT FEE: $ 7�