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HomeMy WebLinkAboutBlde-22-003555 Commonwealth of Official Use Only /L., Massachusetts Permit No. BLDE-22-003555 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:12/27/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 83 LAKEFIELD RD Owner or Tenant LATSHAW GEORGE R JR Telephone No. Owner's Address LATSHAW ELIZABETH, 83 LAKEFIELD RD, SOUTH YARMOUTH, MA 02664 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: 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 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 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump ' Number Tons KW No.of Self-Contained 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ANDREW G THOMAS Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 ECHO LN, CHATHAM MA 02633 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 &e'Le9r/etbe CommoewaaRI oil//Iaddac4tuett6 Official Use Only it--; R cc��,, ("� Permit No. .L�tparfnu cc77nl o� }irs Jirvics3 f(- Occupancy and Fee Checked ''. ' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) I 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 I.NFORMAT7ON) Date: lz 1). / 2 City or Town of: y 04 i'& Tt To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below, i Location.(Street&Number) V3 ic� e%L�t G 1 d 0� Owner or Tenant Telephone No. Owner's Address 13 1 a k _\"i t 1 ‘‘da di Is this permit in conjunction with a building permit? Yes E No (Check Appropriate Box) Purpose of Building cc s t?t r1-I rG l Utility Authorization No. Existing Service A 0 b Amps 1 (3/ d tl°Volts Overhead /7 Undgrd C No.of Meters 1 New Service Amps / Volts Overhead r Undgrd C No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ik.c C0aa.* Gi ME po It( 14,21, .-ff.`.aics ct9, 1<( ( . cs.ik# Completion of the following table may be waived by the Inspector of Wires, Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grad. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches I No.of Gas Burners 1 No. Initiatinnggon Dete and In Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Meat Pump Number Tons KW .No.of Self-Contained Totals: _.._...".....`._. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Munkipal ❑ Connection No.of Dryers Heating Appliances KW Security Systems:} No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. H}drornassage Bathtubs No.of Motors Totai HP Telecommunications Wiring. No.of Devices or Equivalent - OTHER: Attach additional detail f desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (r fib,vv (When required by municipal policy.) Work to Start: 11 1 d 1/)1 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 0 OTHER ❑ (Specify:) I certify.under the pains and penalties of pedury,that the information on this application is true and compkte'1 FIRM NAME: III oe^ - GA[tck) 5t d� (VtC-S 5nC LIC.NO.: 41sa"� nS L1t Licensee: A q d it w _I ll v t .S Signature__y,,." 7.-2-xi LIC.NO.: ��}} (If applicable,enter"exempt"'tithe license number line.) Bus.Tel.No.: (j17 '3.35-g 7 q Address: 7 -4,111, 1 a nti C 1 a i b 5r‘ /`r hl 7. 01 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: lam 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. I PERMIT FEE:$