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HomeMy WebLinkAboutBld-19-006980 co Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-006980 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:6/11/2019 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) 61 BRADDOCK ST Owner or Tenant WARD ROBERT Telephone No. Owner's Address WARD LORI, 34 SCHAEFER AVE,WESTWOOD, MA 02090 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: Wiring for 3 season room. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 No.of Total Transformers KVA , No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 4 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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: 1 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: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 51391 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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: $75.00 q. 7(-1/( a -e._ a(j 3/;9 - 7/ - f I dell -eon I N sp. / uoi ...... ,,, Commonwealth h o/2171,46,,chtt ,_ /r Official Use yq b/� 1_ 1Japarfmard o/,_yirs Serviced Permit No. - f BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,(Rev. I/07] (leave blank) APPLICATION FOR="PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 6�7 j f T City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives otice of his her in on to perform the electrical work described below. i=--J Location (Street&Number) ct e, /‘.. Owner or Tenant L: c t -i- LOvlt Telephone No. - G :a Owner's Address'3 9 SciA Qt-e.P-(,t- PO $2, 111�0Ofl 47 Is this permit in conjunction with a building permit? YesK No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. .. -"Existing Service Amps / P Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr 0 No.of Meters Number of Feeders and Ampacity Lo�. : nand Nature of Proposed Electrical Work: "1/(��'�/ " f O(3/\ A, ,1, tld.J _ 3 S:2 a Sd�✓ Cat) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cei1.-Snsp.(Paddle)Fans / No.of Total Transformers ) ,4 0 No. of Luminaire Outlets D0,./ Ohs,'No.of Hot Tubs Generators KVA / V • No.of Luminaires Above In- No.of!�m en ham - Swimming Pool arnd. ❑ grad. ❑ cy g Battery Units No.of Receptacle Outlets Zit No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and cTotal � Initiating Devices Tons No.of Alerting Devices No.of Ranges No. of Air Cond. V 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❑ Municipal Connection ❑ OtherOther - No.of Dryers Heating Appliances KW Security Systems:* \� No.of Water Kam, No.of No.of No.of Devices or Equivalent ql Heaters Signs Data Wiring: `1Ballasts No.of Devices or Equivalent No. HYdromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: _ No.of Devices or Equivalent /C47V OTHER: G'tJL L p G� �� l� I Attach ad anal detail if desired or as res ed by the Inspector ofWin Estimated Value of Electrical Work (When required by municipalpolicy.) Work to Start: Inspections to be requested in accordance with MEC Rul 0,and upon completion. Ar. 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.BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties o \, f perjury information on this application is true and complete. FIRM NAME: ( �� r- (,J I that the(-0)_ ekl1 Cir.t C l AA /✓C LIC.NO.: Licensee: (If applicable,5 "erempt"in the license nu er line.) Signature `� LIC.NO.: Address: © �� �� • /,. �Q�, �� ✓ Bus.Tel.No.: (j J `Per M.G.L. C. 147,s.57-61,security work requires Department ent of Public SafetyAlt.Tel.No.: k l �z OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Lin.No. required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner r w er coverageW n— o— Owner/Agent ❑owner's a end Signature " al Telephone No. PERMIT FEE: $ '