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HomeMy WebLinkAboutBlde-22-003709 Commonwealth of Official Use Only �\ Permit No. BLDE-22-003709 ' Ems, K L Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:1/4/2022 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) 14 LILY POND DR Owner or Tenant Sue Ford Telephone No. Owner's Address 14 LILY POND DR, 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans N Total Transformers \an 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 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices 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 ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Euuivalent 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: A J PULLEY Licensee: A J Pulley Signature LIC.NO.: 21843 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:289 QUAKER MEETING HOUSE,RD,E SANDWICH MA 025371366 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requi s 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 my 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 Crommonuwsa/ih o/rliaddaduissild Officialia Use Only �] ►!_.- /, c� c7 Permit No. Ev[� 3 7 0 ��1- JJspartmant o�.lirs&Paiced Occu anc and Fee Checked e �` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1p07]y (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: 17 / Z 7/2l City or Town of: ,�*1,,,,.0,�.rN To the Inspector of Wires: By this application the undersigned ves notice of his or her intention to perform the electrical work described below. Location(Street& Number) iq r,l,_, PON,', !Zip Owner or Tenant S OE /per, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Pirs,1r` ,✓4l b,,,}„,,-.1 i,..lt_ Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd❑ No.of Meters Mell) New Service Amps / Volts Overhead n Undgrd ❑ No.of Meters Number of Feeders and Ampacity �'1 Location and Nature of Proposed Electrical Work: aU i a6 0c ipw4L4.i.,.Ewr l2 a it. ....ifs. Completion of the followingtable may be waived by the Inspector of Wires. tal No.of Recessed Luminaires No.of Ceil: p Sus . Paddle FansTf( ) Transformers KTVA 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 v No.of Receptacle Outlets CD No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches0 No.of Gas Burners /I. ?tal Initiating Devices � No.of Ranges No.of Air Cond. Ton No.of Alerting Devices 111 Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices n No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection `^ No.of Dryers Heating Appliances KW Security Systems:* 1No.of Devices or Equivalent .0 No.of Water KW No.of No.of Data Wiring: J Heaters Signs Ballasts No.of Devices or Equivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: No.H y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. y 0 Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ,Z/27 hi 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 [ ' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: l-ir-.i. aLA�,4s 1 Eu-Znit` LIC.NO.: Licensee: 4.3 0i.v..et-- Signature LIC.NO.:elzikt/3 (If applicable,en er "exempt"in t e license number line.) Bus.Tel.No.: S`b,K3(t).V3i3 Address: R t). e33-,',i t 401 S. ;)rju,N,11S I•t A CV 44#0 Alt.Tel.No.• IWf> *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"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 signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.