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HomeMy WebLinkAboutBLDE-19-003513 —` 'V v Official Use Only "� Commonwealth of Permit No. BLDE-19-003513 � _ Massachusetts 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)n Date:12/10/2018 City or Town of: YARMOUTH W fl t To the I for of Wires: By this application the undersigned gives no ice o is or er in en ion o pe a ec ca work describ( below. ^ Location(Street&Number) 228 PINE ST / 074114 Owner or Tenant PECK CYNTHIA H Telephone No. Owner's Address 13823 FAR HILLS LN, DALLAS,TX 75240 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 fan&install two vanity lights. 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- ❑ No.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/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 ❑ 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: Richard F Chipman Licensee: Richard F Chipman Signature LIC.NO.: 12224 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 174 MILLSTONE RD, BREWSTER MA 026312034 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 fiCiUGAI C3 f< i -)VAIAle --- CerA- )147a ( .,3)o to) oteva-otent Kc - - emu P_ t5 co .?'42' - Commonwealth off//lassachadetts • Official Use Only _ 3 ri = 2eparlmeni of emirs Serviced Permit No. ` - 3� l __;,__ . _I _45 i_ BOARD OF FIRE PREVENTION REGULATIONS Occupancy l/07cy and Fee Checked) ----1 [Rev. 1/07] (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE ALL 17VFORMATIO1 j Date: /Z f O l8 City or Town of: YARMOUTH To the Inspector of Wires: By this application the µndersigned gives notice of h' or her intention to perform the electrical work described below. Location (Street&Num er) . ,2 2 E3 t14 e 5'4✓,�c t' Owner or Tenant N►C O/e G/1JL wl Telephone No. ,v) Owner's Address Is this permit in conjunction with a bedding 't? Yes C<^� / No ❑ (Check Appropriate Box) Purpose of Building itWOde/ tr'K1S pe t 4 O. k t' V ✓s'�:3'l Utility_Anthotizatioa-Na, Existing Service Amps I Volts Overhead ❑. Undgrd❑ No.of Meters ). New Service Amps / Volts Overhead❑ Undgrd Number of Feeders and Ampacity ❑ No.of Meters .* L tion and Nature of Proposed E ectrical Work: — / ` � �ft'illi,/e-,4.5 — fetlicr_. 1/hdry . (E . 1� l v4�(� 6-vt �t - r r �iK Completion of the following table may be waiv 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 Swimming Pool Above 0 In- tvo,of Emergency Lighting - Ernd- g d. 0 Battery Units n No.of Receptacle Outlets No.of OilBurners ' 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 Tons No.of Alerting Devices No.of Waste Disposers Heat Pump(Number I Tons H KW No.of Self-Contained Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of 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 municipal policy.) Work to Start: /2,-rb i,3 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 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 at (Specify:) I certify, under the p !I penalties of erf u ,that the inf nnation on this applic - n is true and complete. FIRM NAME: i©fs?y;�.l &iez ,e- Gt� (/ Licensee: �� LIC.NO.: ��� 7 v5Se Signature (If applicable,enter,:* t' r e numbe ,) LIC.NO.: � L . Address: p �at e- d Bus.Tel.No.: ��f{Z�_C7/f J Per M.G.L.c. 147,s.57-61,security work requires Department/�/� Y/ Alt.Tel.No.: of Public Safety"S"License: Lic.No. ;:r- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability S required by law. By my signature below,I hereby waive this requirement. I am the(check one nce coverage normallys e t. Owner/Agent0 owner ❑owner's a ent Signature Telephone No. PERMIT FEE: $