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HomeMy WebLinkAboutBLDE-19-004405 Commonwealth of Offcial Use Only Permit No. BLDE-19-004405 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) Date:1/31/2019 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) 414 PINE ST Owner or Tenant POOLE WILLIAM H JR Telephone No. Owner's Address 414 PINE ST, SOUTH YARMOUTH, MA 02664-3010 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: Fished basement&addition. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 3 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 5 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 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 ❑ 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: SHAWN JOHNSON Licensee: SHAWN JOHNSON Signature LIC.NO.: 54426 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:410 PINE ST, SOUTH YARMOUTH MA 02664 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: $250.00 Cet Sim Cnsustoruveatth of Maaachcei Official Use Only _ r_ = ara,t„„mt opi,..,�irviars Permit No. �� t r- Occupancy and Fee Checked _ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) 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: City or Town of: YA,RMOUTH To the Inspector of Wires: By this application the Imdersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) y74/ pz;vh' ,5-t Etter' S'©. �//3R"f27 ei1f4 Owner or Tenant SC'p Tr" ,Tah t.!sc3A/ / Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building VL-NTWL Utility Authorization No. Existing Service/00 Amps /2 / ayo Volts Overhead 14, 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: Smi3 fir: ` �/ �cf/Ur/ � Ex�Str`,v t FiM/;,slsti/ Completion a fthefotable may be waived by the Inspector of Win. No.of Recessed Luminaires L/' No of Ce:7.-Susp.(Paddle)Fans No.of Tom 7 Transformers KVA No.of Lumiaaire Outlets 3 No.of Hot Tubs Generators KVA • No.of Luminaires S Pool Above In- No.of Bmergencr Ughung g and. ❑end ❑ Batters Units is No.of Receptacle Outlets ,j No.of Oil Burners FIRE ALARMS No." of Zones ` No.of Switches 3No.of Gas Burners 'No.'ofDettection and InitiaftE.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 Municipal Local Q Connection ❑ Other No.of Dryers Heating Appliances I{yl, 'Security Stems:* No.of Water No. No.of Devices or Equivalent of No.of HeatersKV ' 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 f desired or as required by the Inspector of Wires. 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. 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.) !certify, under the pains and penalties ofperlury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: AWaln! !)disc+." Signature -'6 / S (If applicable.enter"exempt"in the license number tins) Bus.LIC.NO.: 8 Address 5(/b P1 Al � . TeL No.- �e7 �!!�'`�" /Prt OrYdGf/ Alt.TeL No.: • ' .46 j *Per N.G.L.c. 147,s.57-61,security work requ Pamnent of Public Safetyi -`"S"License: Lic.No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally '. required by law. By my si low,I hereby waive this requirement I am the(check one)r,/owner owner's Owner/Agent t la ❑ age ' Signature Telephone No car- 5515! PERMIT FEE:$ 1