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Home My WebLink AboutBlde-22-003297 �.. Commonwealth of Official Use Only yr 4 Massachusetts Permit No. BLDE-22-003297 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:12/10/2021 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) 15 JEFFERSON AVE Owner or Tenant OLSON JOHNATHAN E Telephone No. Owner's Address LARRIMORE KIMBERLY, 15 JEFFERSON AVE,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 No 0 Cati � 1,vo Purpose of Building Utility Authorizatio o x= • Existing Service 100 Amps Volts Overhead 0 Undgrd 0 i Meters New Service 200 Amps Volts Overhead 0 Undgrd 0 No. • ers Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. 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 Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine 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 Ballasts Data Wiring: Heaters Siens 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: PAFOF ELECTRIC Licensee: Dominic Gitiiba Signature LIC.NO.: 100030 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: 5086670174 Address:6 Pleasant View Road, Spencer MA 01562-2423 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 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 RECEIVED /� a� menonwea/h o/raoacliuselle OfficialUse Only * = t Permit No. �'�� A = 'I EC 0 9 2021 cc77 ..q 7 Sparlmenl o� `ire�erviced t f_ Occupancy and Fee Checked y,- :r't_DI R4+RO MRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) -Y. 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: -�� ( 2 City or Town of: a ��o J �►1� To the Inspector of Wires: n By this application the undersign d gives notice of his or her intention to perform the electrical work described below. 0 Location(Street&Number) (S ;j€.r C.0 f, •-t-Q_, .. Owner or Tenant \5 O Telephone No.`��i-►.a.i z-' -3-6 (/ Owner's Address (/ Is this permit in conjunction with a building permit? Yes ❑ No Er (Check Appropriate Box) ( Purpose of Building Utility Authorization No. -9'3�2 ct� rr/ Existing Service (,: Amps f' /235'.Volts Overhead Er Undgrd❑ No.of Meters I . New Service �L �.�^ Amps 1 Za/ .c&Volts Overhead LJ Undgrd ❑ No.of Meters f Number of Feeders and Ampacity ( d Location and Nature of Proposed Electrical Work: s.e-, i c c e_ \,),:sCsCa-,asQ !!!cb Completion of the following table may be waived by the Inspector of Wires. 0 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 SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting t grnd. grnd. Battery Units No.of Recept{ le Outlets No.of Oil Burners FIRE ALARMS No.of Zones ., i/I— No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 0Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number:. LTons KW No.of Self-Contained Totals: Detection/Alerting Devices 0.--- No.of Dishwashers S ace/Area HeatingKW Local❑ Municipal 0 Other �(� p Connection No.of D ers Heating Appliances KW Security Systems:" ''Y No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunicationsqu Wiring: Y g No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3 O(1)O (When required by municipal policy.) Work to Start: t 'IQ` .'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 cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIR M NAME: \D `)- ' ��G�r'C.\ C p r — G LIC.NO.: 1 t C)' ) Licensee: '1p - <- C GS'"A \ ,Signature s LIC.NO.: \O�,' 3C7 (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.v5 ' c . F,1-.4 kc),- Address: Alt.Tel.No.: *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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ t