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Home My WebLink AboutBlde-21-006699 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-21-006699 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:5/19/2021 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) 5 BUCKWOOD DR Owner or Tenant GURSHA JOHN L Telephone No. Owner's Address GURSHA SARINE,44 ZAIN CIR, MILFORD, MA 01757-2831 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 ❑ 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: Addition for bathroom. 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 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 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 D HOLLISTER Licensee: Michael D Hollister Signature LIC.NO.: 10071 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:85 N DENNIS RD, S YARMOUTH MA 026641017 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 Rco, maeesc Use Or.6(p. 1 - illy2epartnatt of sa.7inr wiue Permit No. at .\,,,,.. BOARD OF FIRE PREVENTION REGULATIONS 1/07]Occupan�and lFee Checked . ' (leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 V (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S f ) es 1 a City or Town of: y Aic �017r 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) :I-04Af 4 A/ /i 6, V R Owner or Tenant Telephone No.7 e 72 to,-/ . 0 t Owner's Address 5- C i/VOD D LAPG e Ai Is this permit in conjunction with a permit? Yes [B. No ❑ (Check Appropriate Box) iPurpose of Building P t C & Utility Authorization No. ""i 4 Existing Service/V Amps 120/ 2 Onfolts Overhead IX Uadgrd ElNo.of Meters New Service Amps / Volts Overhead 0 Undgrd No.of Meters Number of Feeders and Ampadty ) O Ai / — J a R:31:301-- Location and Nature of Proposed Electrical Work: e6. , Co lotion of the foil table tts ,be waived by the Inglector of Wires. vi Total) No.of Recessed Luminaires No.of Ceit.-Snip.(Pane)Fans To.of L Transformers KVA n 1 No.of Lumi�n Outlets No.of Hot Tubs Generators KVA PoolAbove In- No.or Emergency Lighting �k No.of Luminaires Swimming wed, ❑ mid. ❑ Blowy Units No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners �a afDden and • Initiating Devices E 0No.of Ranges No.of Air Coed. Tots! No.of Devicontainedes Tons No.of Waste Disposers 'Heat Pump Totals: Number Tons KW _'NO.of Self-C Ni. Devkes of Dlehwashets Space/Area Heating KW Local 0 M ❑ Other No.of Dryers Heather Appliances KW Security * ofDevices or Equivalent No.of Water KW No.of xBaai of Data Wiring: Heaters S T No.of Devices or ' , , , t No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Eq . t OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of • Work: G (When required by municipal policy.) Work to Start / I Inspections to be requested in accordance with MEC Rule 10,and upon cowletion. INSURANCE CO 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 0 BOND 0 OTHER 0 (Specify:) I cat ,ender the pains and penalties of peeps*,thp the hyb anation on this ' is Uwe and cotes FIRM NAME: ph 1 Cif 614- (, D o cL i c f LIC.NO.: J®D 7l—3 Licensee: /IA1K'c. �LIC.NO.: (((applicable,wrier exempt"in the I' ,anther lineA Bus.TeL No.: 7 7 to '.�l ci Address: At. �� _/,‘"( e .G4 5 r - f"0 Alt.TeL No.: *Per M.G.L.c. 147,s.57-61,security work requires Department Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hove the liability insurance a normally Owner/Agentrfiredbylaw. By my signrdbre below,I hereby waive this requirement. I am the(check one)0 owner owner's agent Signature Telephone No. I PERMIT FEE:$ I