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HomeMy WebLinkAboutBLDE-21-002702 or r Nli Commonwealth of Official Use Only rl Permit No. BLDE-21-002702 1- Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.I/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:11/12/2020 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) 72 TANGLEWOOD DR (A3 a J 'f8 7p Zf Owner or Tenant GALPERIN MICHAEL Telephone No. Li 0 k(78-4 8 Z Owner's Address GALPERIN MAYA&LEO, 36 ALTON PL APT 1, BROOKLINE, MA 02446 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 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service&replace smoke detectors. 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 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 6 Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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: Rich M Melvin Licensee: Rich M Melvin Signature LIC.NO.: 11476 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Addres 7 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:$50.00 g 1� 3I7 Alc et IA �9bil/k Conusmenw.alh of cc-masaac Official Use Only �7. • i7 �epartnuaE a�.ti„slue Permit No. - 2( Q nd Feec BOARD OF FIRE PREVENTION REGULATIONS [Row.Occupa 1/07]ncy a(�� Che)ked 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 INFORMATIOAV) Date: I I I 4 / tCity or Town of: JA iZ/Yle Cl 41► To the Inspector of Wires: �iBy this application the undersigngives notice of his or her intention to perform the electrical work described below. Q Location(Street do Number) -7 . 'jig A..)9 I.c/4.41)rJ l7ri-1 VC Owner or Tenant 7/7/e/i?�G 61) Qt/d4J Telephone No. 6 l?7G.� 3l'.l4n t� Owner's Address J4 /�LT?�.v f Ate/ %/2otr/.L/ti'r/ /14R 4a y i(Co . '� Is this permit In conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building D cU ru_,,,J � Utility AuNNrization No. xv Existing Service /o 0 Amps /Zo II /Volts Overhead t1 ® Undgrd❑ No.of Meters Z New Service /00 Amps /20/ Z y0 Volts Overhead® Undgrd❑ No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Metrical Work: Apo 4 ©/f Ski LC d Sr rzek-c Pc ciaA 4614,,t�f,tmj Completion of the lfolkrwinktmabk may be waived by the I !I Wiret rn lb No.of Recessed Luminaires No.of Celt-Snip.(Paddle)Fans Luminaires ..or Transformers icy © �"'� Q No.of Luminaire Outlets No.of Hot Tubs Generators KV z ,,.,, MI -4: No.of Luminaires Sw�miag Peel Abgove ❑ In- ❑ No. U� I'1 I nfts o ii N' < tr No.of Receptade Outlets No.of 011 Burners FIRE ALARMS No.of as rn ' No.of Detection and �` No.of Switches No.of Gas Burners IdfVtlat Devices i 0 l l r No.of Ranges No.of Air Cond. Total ns No.of Alerting Devices 6 • No.of Waste Disposers neatPump Number I Tons, KW 'No.of Totals: Devices CIN No.of Dishwashers Space/Area Heating KW Local❑ 0 Other KW Security No.of Water iring: 'C.) Heaters , HeatingAPP of No.of Data e.ofS=or Equivalent Signs Ballasts No.of Devices or ' .'Bivalent No.Hydromassage Bathtubs No.of Motors Total HP T of Devices or Eq 1 t c) L OTHER a * Attach adaiitional detail rdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work:440/4,aO e° (When required by municipal policy.) ct 2 Work to Statt: ,4 S p f 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 ra BOND 0 OTHER a (Specify:) /SGox , / v) ` � I certify,under die pains and penalties of perjury,that the bnforatadon on fhb applcaton b true and complete. 2 FIRM NAME: )Z i C H 111 Cc-c.I C6ctx/c/a n LIC.NO.: //V n,4 0N. Licensee: E iCl-1 VYl twl.� Signature LIC.NO.: //%/X 0 '�rJ (If applicable,enter"exempt"in the license number line.) /-4._.."/' Address: <Q b.) L/ILo1PFiec n IZd out cT i V�� mA o�0 cis' Ale.TeL No.: s o��sya il�� 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public VI Safety"S"License: Lic.No. D 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)0 owner 0 owner's agent. Owner/Agent1 Signature Telephone No. (PERMIT FEE:$ SO.'