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HomeMy WebLinkAboutUntitled or Commonwealth of Official Use Only �' �' Massachusetts Permit No. BLDE-19-006422 �' 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•5/13/2019 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) 39 DANBURY ST Owner or Tenant YENULEVICH MARY Telephone No. Owner's Address TELFORD STEVEN, 39 DANBURY ST,SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes ❑ 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: Renovation Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 30 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 Abe ❑ In- ❑ No.of Emergency Lighting grndov grnd. Battery Units No.of Receptacle Outlets 55 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 26 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 1 Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers 1 Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers 1 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: Luciano B Miranda Licensee: Luciano B Miranda Signature LIC.NO.: 53429 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 11 LEXINGTON ST, BELMONT MA 024785010 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: $150.00 c2t - ( oWuo twGi ay Gc0/-7 C „ z %G'. C0,7iper 17 I,tJG_ i s Ga l r� aL 7'he o6 �� � �vr f sr S Yc���-rv�, fh imp - J 4 - co - 6 9.Z.Z { r are / ue f1. " - 5ha111-/I✓� h qc/ - Tti Cr)rri 2e tc The 1;c2 r Cx)cLy AeL rd.02 7 c © r - • IRCE1VED ; ._ ._ ..__. - A! UG2? 2IIJJ ji BUlLDING DET ENT Hv