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Home My WebLink AboutBlde-21-006896 Commonwealth of fin Official Use Only Massachusetts Permit No. BLDE-21-006896 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:5/27/2021 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) 12 NAVAJO RD Owner or Tenant MADEJ KATHLEEN E Telephone No. Owner's Address MADEJ RICHARD A, 88 WADSWORTH ST, GLASTONBURY,CT 06033-3008 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Septic pump&alarm 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- ElNo.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 1 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 Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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:) '77 IP Li 1' -0373 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Lazar Mitev Signature LIC.NO.: 56442 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 !", Official Use Only oil yadachdstid -t . Permit No.y. L�1 "-La k q s 2aPartmenf o gins ServicsdP " t Occupancy and Fee Checked 'i 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 i PI E.4: E PRINT IN INK OR TYPE ALL INFORMATION) Date: ,9g 26/20?7 City or Town of: Yt/^I EIU1/vI To the Inspector of Wires: ley !his;application the undersigned gives notice of his or her intention to perform the electrical work described below. LU•at;uin (Street& Number) 12, /` etii`a j'c�� :)»rier or Tenant A161/OI C1.C' �1 Telephone No. 8 / 0,j c t.tt,iier's Address is saris permit in conjunction with a building permit? Yes ❑ No 2 (Cheek Appropriate Box) Purpose of Building Utility Authorization No. EAisting Service .(04) Amps /24:Q Volts Overhead ET Undgrd❑ No.of Meters '�e',ti Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters \ualb_r of Feeders and Ampacity Li—:at ic.1 and Nature of Proposed Electrical Work: Wi ik ..- 'l L $yc . Completion of the followingtable may be waived by the Inspector of Wires. !N).of Recessed Luminaires No.of Cell: KVA p Transformers KVA Sus .(Paddle)Fans No.of j.N,,, of Luminaire Outlets No.of Hot Tubs Generators KVA 1 No. of Luminaires SwimmingAbove In- No.of Emergency Lighting Pool_grnd. ❑ grnd. ❑ Battery Units .Nu. vi iteceptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Nu of Switches No.of Gas Burners No.of Detection and, Initiating Devices 1 iN.0, of Ranges No.of Air Cond. Tonsl No.of Alerting Devices of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices al n No. oe Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other i pp, HeatingAppliances KW Security Systems:* . of DryersNo.of Devices or Equivalent :No. of%ater KW No.of No.of Data Wiring: 1 Heaters Signs Ballasts No.of Devices or Equivalent t i stromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent (J lii'R: Attach additional detail if desired,or as required by the Inspector of Wires. East :nar d Value of El ctrical Work: (When required by municipal policy.) `,V urk to Start: 0 .6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. t Ntit.RkN'CE CO FRAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless he i Uc nsce provides proof of liability insurance including`completed operation"coverage or its substantial equivalent. The ul klasi r;ned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CI if( i. ONE: INSURANCE ❑ BOND ❑ OTHER 0 (Specify:) cc-r tij i, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: cCdyi / 5f f((4 S Z LIC.NO.: Licriisee: Z/it eYrlev' Signature LIC.NO.: dre9m d ,'•: l r.,,ble.enter "exempt-in the license number line.) Bus.Tel No.: iLi e,,: L? 2/ V Z /k n/S / t"z-0 e2 2G"" r 5 j Alt.Tel.No.: 'i',,I 10.G.L. C. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. 0\\Nt;lt'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally ,-,:k.i Aic by law. By my signature below. I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. ter,cer,Agent i1;:iat;:re Telephone No. PERMIT FEE: $