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HomeMy WebLinkAboutBLDE-20-000987 o• ttk Commonwealth of Official Use Only f1- % Massachusetts Permit No. BLDE-20-000987 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:8/22/2019 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) 135 SOUTH SHORE DR UNIT 1 Owner or Tenant MILLER JOHN L SR Telephone No. Owner's Address MILLER NANCY,8912 SEVEN LOCKS RD, BETHESDA, MD 20817-2056 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 2 GFCI receptacles ;-A '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 No.of Luminaires Swimming Pool Abe ❑ In- ❑ No.of Emergency Lighting grnov grnd. Battery Units No.of Receptacle Outlets 2 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 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: Joseph P Pignolet Licensee: Joseph P Pignolet Signature LIC.NO.: 20170 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 153 SANDWICH RD,TEATICKET MA 025365603 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: $80.00 D of u (i, teg- l.-ommoruvecits of Massachaseits Official Use Only il / 2 eP of girt Services Permit No. (j2U�egtq�_ i z �' -. BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked • [Rev. 1/07) (leave blank) w 1 4 I APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK''� All work to be a performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 c'` • EPRINT IN INK OR TYPE ALL INFORMATION) Date: q._')-� a 9 i t V, = I Z City or Town of: YARMOUTH To the Inspector of Wires. vLLI Q . ; Yi . application the pndersigned gives notice of his or her intention to perform the electrical work described below. I re m o <lion (Street&Number) J 3 6' 0,�; H 1'.fL,� I v t >z /'j ,� • er or Tenant t Cv T i tv s �'�`�e '� 'I ' �'' �� �, Telephone No. Owner's Address t S '' Is this permit in conjunction with a building permit? Yes ❑ No . ❑ (Check Appropriate Box) Purpose of Building C01 wtv.-,,- L/et.( Utility Authorization No. Existing Service (12-0 Amps LZC/ . Volts Overhead ❑. UndI grd 0 No.of Meters New Service Amps / Volts Overhead El Und >'z'd 0 No.of Meters Number of Feeders and Ampacity ._ b 0 4-444 Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Celt.-Susp.(paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above El No.of]Emergency Lighting mid. grnd. ❑ 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 Initiating Devices y No.of Ranges No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained Totals: Detection/Alerting_Devices No.of Dishwashers Space/Area Heating KW Local❑ Munlcipal Connection 0 Other No.of Dryers Heating Appliances Dili Security Systems:* No.of Water No. of No.of No.of Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: • No.of Devices or Equivalent _ Attach additional detail if desired or as required by the Inspector of Wires Estimated Value of Electrical Work: (When required by policy.) municipal -., Work to Start: P cy�) 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 C the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The 1 ` undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. ,.I CHECK ONE: INSURANCE Di BOND 0 OTHER 0 (Specify:) NJ I ceritfy, under the pains and penalties of ury,that the information on this application is true and complete.FIRM NAME: -1 Licensee: s / i , I`C___ i LIC.NO.- g4t‘/t. S r ! r .`C s1 C1 i 'c , Signature in (If applicable,enter"exempt"in th license.number Ibiie.)JJ "`C'NO' © l on Address: t';3 Sep %+t?�.�. t,(-l-tl�C Bus.Tel.No.: 1,. � A ,_I 'Per M.G.L. c. 147,s.57-61,security work requires Department t $ Alt.TeL No. qu arttrirnt of Public Safety"S"License: Lic.No..-----_______ - OWNER'S INSURANCE WAIVER: I sin aware that the Licensee does not have the liability required by law. By my signature below,I hereby waive this requirement. 1 am the(check one ownerice coverage n o [ Owner/Agent 0 ❑owner's a ent.Signature Telephone No. PERMIT FEE: $