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Home My WebLink AboutBLDE-21-000839 a.- Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-000839 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:8/20/2020 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) 6 FOREST GATE VILLAGE Owner or Tenant KOSAK BERNARDINE Telephone No. Owner's Address 6 FOREST GATE,YARMOUTH PORT, MA 02675-1459 Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec ppropriate Box) Purpose of Building Utility Authorization No. O ) i/ Existing Service Amps Volts Overhead 0 Undgrd ✓✓klib•:,' `s/ New Service Amps Volts Overhead 0 Undgrd e: _____ Number of Feeders and Ampacity � Location and Nature of Proposed Electrical Work: First floor bathroom renovation. i_____ /v J /U :47 Completion of the following table m d sector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of tal : Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators VA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 4 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 1 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 ❑ 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: Matthew P Reilly Licensee: Matthew P Reilly Signature LIC.NO.: 40299 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:43 Brock St,Apt 2,Brighton MA 021352662 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 tDsc Ct13(�'O Coninionwsalg o////amac%u ath Official Use Only I.- 1�� _�� cc�� cc77 Permit No. 2 LSE-2- -vto 839 • _- 2epar meat of irs�ervicss Ail a" Occupancy and Fee Checked r 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 C),527 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO,N))y Date: ?11 7 City or Town of: ' ail0 v�I J To the Inspector of ires: By this application the undersigned gives notice of his pr her in tion to perform then electrical work described below. Location(Street&Number) ` �''e '- are. /z0�-D Owner or Tenant Pe)L ,9yt/Y) `, ,j CcC l� Telephone No.-7 -di ?— Owner's Owner's Address � Is this permit in conjunction with a building permit? Yes EK----'1%:To ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service/l) Amps / Volts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /, '7Z Completion of the following table may be waived by the Inspector of Wires. otal No.of Recessed Luminaires No.of CeiL-Sus .(Paddle)Fans No.roof TVA P Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grad. ❑ grad. ❑ 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. Totals No.of Alerting Devices rs Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ r No.of Dryers Heating Appliances KWN Security Systems:* f Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent dromass a Bathtubs No.of Motors Total HP Telecommunications Wiring: . ._- .--ale:Hy ag / Na of Devices or Equivalent ,'If°ITIER: Attach additional detail if desirect or as required by the Inspector of Wires. Estimated Value El is Wor S v" (When required by municipal policy.) ,5 Work to Start. Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE V 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 71 undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER ❑ (Specify:) I certify,under the ns penalties of • ry,t the o D u on.,this ' atio is true and comp FIRM NAME: ` � ! C (a / ci 1 LIC.NO.: 0 Licensee• ( e 1 higaituri �,„;l 2s=-e 1' LIC.NO.: (If applicable,e t empt" . the lic e n line.) Bus.TeL No.:(p( "`[J Address: �j //��t �) 6I 6� q 6\ Alt.Tel.No.: *Per M.G.L.c. 14 ,s.57-61,security wo regi&ires 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 I PERMIT FEE: $ Signature Telephone No. t