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HomeMy WebLinkAboutBLDE-20-000603 Commonwealth of Official Use Only -or 0.- Permit No. BLDE-20-000603 II- Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:8/1/2019 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) 18 PINE CONE DR Owner or Tenant KELLIHER DAVID A Telephone No. Owner's Address KELLIHER SUSAN D, 345 W HARTFORD AVE, UXBRIDGE, MA 01569 /� Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) l Purpose of Building Utility Authorization NikK, r5 Existing Service Amps Volts Overhead 0 Undgrd 0 inters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Repairs to service due to tornado. 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 Initiatinc 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/Alertine 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 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: Joseph Bomba Licensee: Joseph Bomba ' Signature LIC.NO.: 18061 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 CRESCENT LN, DOUGLAS MA 015162567 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:$50.00 1 g(A(9 e 0 'D by # c te.v ek49 a- Commonwealth of///addac ltd y _Official Use On c3cc•�� c7 �^ 0 _ /il_= -/ . 2.partn nt o{firs Serviced Permit N6� W� :.=---T cZ - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK r CI f- All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 "g ' ►E PRINT IN INK OR TYPE ALL INFORMA77019 Date: g ric W 1 1 City or Town of: YARMOUTH To the Inspector of Wires: CO >E Byfhi$application the pndersigned gives no ' e of his or her intention�p perform the electrical work described below. vl w ' Lo t} n (Street&Number) / ' note e e y,i --� N 90 l ( I O e1'orTenant 1('� ¢'ate, is-t/ cv� Telephone No. SOg�/A.q� . L i Q 04' e s Address 3�S Vest//qi')/ sr a , A 0/5`6q t n,ermit in conjunction with a building permit? Yes 0 No / �' L� (Check Appropriate22 Box) of Building Utility Authorization No. o23J24'10 Existing Service XV Amps /,%Oi q0 Volts Overhead C— Undgrd / q ❑ No.of Meters New Service 02C0 Amps ad /a290 Volts Overhead❑// Undgrd tr 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 7("11-4)___D Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Soap.(Paddle)Fans No.of Total is Transformers I{V,t, No. of Lusninaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting td- ❑ ornd. ❑ Battery Units g 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 No.of Ranges No.of Air Cond. Total , Tons 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 Lord❑ Municipal Connection ❑ Other rJ No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of No.of Devices or Equivalent KHeaters ' Signs Ballasts Data Wiring: No.of Devices or Equivalent S No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work 0� � Gt7 Attach additional detail ifdesired or as required by the Inspector of Wires. �. (When required by municipal policy.) Work to Start: r 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 cera is in force,and has exhibited proof of same to the permit issuing office. ;: ov CHECK ONE: INSURANCE BOND ❑ OTHER. ❑ (S F I certify, under the p ins and pets off ) pperlu that the information on this application is true and complete. ;� FIRM NAME' �.. d �' 1• ��� •Licensee: se�'Gt, �,. ,,/Q Signature LIC.NO.: /�_ —> (If applicable,enter exempt in tote li a number - e.) � LIC.NO.: Q��"�' , Address: ( �- � ©/��/ Bus.TeL No.: �w/j7G- j2�' j `Per M.G.L. c. 147,s.57-d I security work ` �_ Alt.Tel.No.:?7q/. �50 requi s Department of Public Safety"S"License: Lic.No. / OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability required by law. By my signature below,I herebyone ❑o insurance coverage n�ly t Owner/Agent waive this requirement I am the(check S afore � wrier El owner's a �t Telephone No. PERMIT FEE: $ 5D----