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Home My WebLink AboutBLDE-20-000613 0Commonwealth of Off613icial Use Only Massachusetts Permit No. BLDE-20-000 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:8/2/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice or his or her intention to pertorm the electrical work described below. Location(Street&Number) 6 COPPER BROOK RD Owner or Tenant SUROZENSKI ANTHONY R Telephone No. Owner's Address SUROZENSKI ALICE L, 6 COPPERBROOK RD, SOUTH YARMOUTH, MA 02664 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: Replacement HVAC. 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 l No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting r, grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones �T- No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total 2 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 M n is pion al 0 Other: P Cect 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: KUNG-PO TANG Licensee: Kung-Po Tang Signature LIC.NO.: 52286 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:518 COTUIT RD, MASHPEE MA 026492351 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: $50.00 neZ ,9- ff42hi 3 Co maw ruusaCtfs of///assac fti >. • Official Use Onl if c� �'7� —t0 ( _ = �_=; UaParfm¢rsf oi�irs S'Qrvius Permit No. E- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked •�.. ' rRev. 1/07] (leave blank) �1I `_' 'l APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL��o WORK N 'a- All work to be�.-1 a performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 tLi c, !La/ I'LEASE PRINT IN INK OR TYPE ALL INFORMATION Date: l-N V LD z I City or Town of: YARMOUTH To the Inspector of Wires: U -t o � r•.i this application the pndersigned gives notice of his or h mt ti�n to perform the electrical work described below. E .cation(Street&Number) A Co/ ` y B j?jv(C Iua , - co u-- ,er or Tenant ](A Q ��5k r Telephone No. 6, 7 Zd Owner's Address Is this permit in conjunction with building permit? Yes ❑ No rp p_S - �� ( � (Check Appropriate Box) Purpose of Building dx , dim Utility Authorization No. Existing Service Amps / Volts Overhead ❑. Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: UYAoi.ce Col- 01aGeiYlZ24 t Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cei1.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimmia Pool Abo In- No.of Emergency Lighuan gAboc ve ❑ rind. ElBattery Units g No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones • No.of Switches No.of Gas Burners P No.of Detection and Initiating Devices No.of Ranges No. of Air Cond. p Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals:1 Detection/Alerting Devices No.of Dishwashers Space/Area Heatin KWCo l ' a g Local D M nn lccipa DI Otter c.. No.of Dryers Heating Appliances KW Security Systems:* No.of Water ' No.of Devices or Equivalent No.of No.of cf Heaters Data Wiring, Signs Ballasts No.of Devices or Equivalent No.Hydrornassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent q, Attach additional detail if desired or as required by the Inspector of Wires. 11 Estimated Value of Electrical Work �`�� (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. (,q , INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless 1i 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 pains I certify, under theandpenalties o � (Specify:) fPerlury,that the information on this application is true and complete. ki FIRM NAME: 4 C,.� see: -Licensee: LIC.NO.: I a see: en ,Id Sig" (l pp t"in LIC.NO.: � -3 ynse nu r II e.) � Address: � l , � Bus.Tel.No.: - -.' 7, ; J Per M.G.L. c. 147,s.57-61,security work requ a artmrnt of Public Safe Alt.Tel.No.:• -,;c- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLic.No. 5 required by law. By my signature below, I hereby waive this requirement. I am the(check one ❑o ce�cove ow owner's Owner/Agent ❑ �,s a ent Signature_ Telephone No. PERMIT FEE: $ �0