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HomeMy WebLinkAboutBLDE-20-000116 Commonwealth of Official Use Only . Massachusetts Permit No. BLDE-20-000116 �- a0BOARD 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:7/9/2019 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) 44 BERNARD ST Owner or Tenant HEALY MICHAEL K Telephone No. Owner's Address STODDARD ROBIN L, 12 KATHARYN MICHAEL RD,YARMOUTH PORT, MA 02675-2406 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: Repairs to service. 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- ElNo.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/Alertinc 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 Sins 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 ifdesired,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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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:OVI, 7 AOf(`l Corn wemsatth of///addac lid Official Use Only R ��_ / -1JaparfmanE o�.lire J Permit No.l:� ad— 0 ( `(-p BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07) (leave blank) APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �,527 c c 1 t —lam f City or Town of: rn J YARMOUTH To the I ctor of Wires: C ) By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. et Location (Street&Number) 1'f Cf Ei t r �ij m or Tenant vw10_ 1r--r l f 1 / '�1�-,.. ,� Telephone Na. Owner's Address !� CF f- ! Is this permit in conjunction with a building permit? Yes 0 No Check Appropriate( pp print.Boz) Purpose of Building Utility Authorization No. Existing Service ` Amps /y©/ t 46eVolts Overhead ! J Undgrd gr ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t/1/ o Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Col.-gasp.(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 Lmergency Lighting - _rnd. omit ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.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 • No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local D Municipal Connection ❑ Omer No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent No.of Heaters ' Data Wiring: 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 f Ele trial Work: ((When required by municipal policy.) Work to Start: !� 2Ur Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE GE: nless waived by the owner,no permit for the performance of electrical work may 'the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivlent.unless e undersigned certifies that such coverage is in force,and has e,�xh,�ib d proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER L�"(Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 44\4.[C,f ",¢.E . 1t- C$t--%{' LIC.NO.: Licensee: i/ R' Signature LIC.NO.: (If applicable.enter"exempt' i e lic efu mb eAr l .) --- Address. , if 1►1 d-P Bus.Tel.No.: J *Per M.G.L. C. 147,s. 7-61,security work requires Departrnnent of Public Sa ety"S"�cen�se:�Al�Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insura overageage n—ormally required by law. B my gin a bel w,I hereby waive this requirement. I am the(check one wner owner's a ign tune � _ ❑ ent Signature p 8 Z OW PERMIT FEE: $ tj b-- ' Telephone Nu�1`t' U-1 r---1 col L-1 'fTe MI I CD 0 1 0 1 -1 , Z WI 5 03