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HomeMy WebLinkAboutBLDE-19-007104 Commonwealth of Official Use Only or rA—. Massachusetts Permit No. BLDE-19-007104 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 / (PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date:6/18/2019 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) 119 HOMERS DOCK RD 11 4' 7 Zz' ac 1 0 Owner or Tenant REYNOLDS TARA Telephone No. Owner's Address 30 HIGH MEADOW CIR, EAST LONGMEADOW, MA 01028 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: Lights&fans in two bathrooms. Ejector pump circuit. 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 ❑ 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 Siens 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: Michael F Simonis Licensee: Michael F Simonis Signature LIC.NO.: 16862 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 1488, EAST DENNIS MA 026411488 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: $75.00 Kid Wt.46(71 a,- _ / -6,09t g(cdeci ( - 4t_r_cie (0((.9(*(.9 eil-- N 7/u i'; '78' 1 ) " .- ' Coryrym,, noruvea[th of///adsara tie _• OffOfjciiaal Usese Only ill ./ dJaParfnumt of 5rs Serviced Permit No. L�( C ` /(tQ ` BOARD OF FIRE PREVENTION REGULATIONS("Z. Occupancy and Fee Checked 'jRev. 1/077 _ Ca lb � •� PPLICAT[ON FOR-PERMIT (leave blank) MIT TO PERFORM ELECTRICAL WORK 1 W I i I All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 I (}�-= 'Z'' • E PRINT IN INK OR TYPE ALL INFORM.�ITION) Date: 6� ILIa City or Town of: YARMOUTH To the Inspector of Wires: ' s application the undersigned gives notice of his r her intention to perform the electrical work described below. �ip , / lion (Street&Number) ��"5 © �� W' c- er.or Tenant /GY Telephone No. s, er's Address .S'-4-7--, --e-- s s permit in conjunction with a building peiW Yes ❑ No ❑/ (Check Appropriate Purpose of Buildtag� le _ __ � `/r/ � PP Priate Box) e f 2 �- cue/ c Utility Authorization No. Existing Service Amps / Volts Overhead ❑, Und g'd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd�' ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t S' FL, C' h-ret f2 e 4-e.c ..e A.14. S j FAN -# S H-o,---o er' t_ i.. (3,1t-$cite cdt r twat-77 t - P <ec. LT5 f - 1=.a 4-J c_17 l 6,r? Completion of the followin table may be waived No.of by the Inspeator of Wires. No.of Ceil.-Susp.(Paddle)Fans Total No.of Recessed Luminaires Transformers KVA No. of Luininaire Outlets No.of Hot Tubs Generators ICVA 1` No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Lmergency Lighting - mid. trnd_ Battery Units 11) 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 I,L No.of Ranges No..of Air Cond. Tons No.of Alerting Devices `F No.of Waste Disposers Heat Pump l Number I Tons 1 KW No,of Self-Contained Totals:l Detectiooe Alerting Devices U No.of Dishwashers Space/Area Heating KW Local Q Municipal Conneciaon ❑ Other No.of Dryers Heating Appliances No.of No.of , Security Systems:* • No.of Water No,of Devices or Ealen quiv t Ci Heaters ' Data Wiring: Signs Ballasts No.of Devices or Equivalent ri` No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: ` J9 OTHER: t r „`. No.of Devices or Equivalent Gi,'-cc� i mod` -eSc c rDtZ furl vt4. Attach additional detail if desirec4 or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by municipal policy.) Work to Start j Inspections to be requested in accordance with MEC Rule 10,and upon completion. ‘.st v, INSURANCE COVE GE: 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 0 (Specify:) �7,t-ze-e/./.s I I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME m,,,,,7,s 4,.. ', - Z v-E LIC.NO.: /(� , Licensee:Mci,-r,o/sma ozr,,s, Signature ��� LIC.NO.: 0` (If applicable.enter"exempt"in the license number line.) —`3� 3� V Address: pep- 0 ,� Veg." Bus.Tel.No.: I "Per M.G.L. c. 147,s.57-61,security work requires Z n Yr/. Iffr9 �46�!� AIL Tel.No.: _g6e7 t) quires Department of Public Safety"S"License: Lie.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's a eat. Owner/Agent 1 Signature Telephone No. [PERMIT FEE: $ �