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HomeMy WebLinkAboutBLDE-22-003965 or Commonwealth of Official Use Only Ei..1 Massachusetts Permit No. BLDE-22-003965 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:1/18/2022 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. r�� Location(Street&Number) 66 HOMERS DOCK RD t g- `6 Owner or Tenant GLODIS PATRICIA A Telephone No. Owner's Address 66 HOMERS DOCK RD,YARMOUTH PORT, MA 02675 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: Rewire kitchen,dining room,&living room. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 15 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 0 In- ❑ No.of Emergency Lighting grad. grnd. Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 10 No.of Gas Burners .No.of Detection and ,Initiating Devices No.of Ranges 1 No.of Air Cond. Tn Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers 1 Space/Area Heating KW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent 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 ❑ 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: LONGFELLOW DESIGN BUILD Licensee: Jeromme Marques Signature LIC.NO.: 22751 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:26 Lake Avenue,Woburn MA 01801 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: $75.00 (3 �! f /4 lw Vim- ki A CV,Aa ,:_ ® Commonwealth° M _ t �� ''' eQ a�ac Official Use r * Only =1=f= e artme `�. LA ; 2 • .RD p °` Senrlcea Permit No. ;39 OF FIRE PREVENTION Occup ancy pancy and Fee Checked "°�"`' ` TION FOR [Rev. 1/07 By __ - -- ] leave blank � ----- work• to be per�ormed;PERMIT thece with TO PERFORM (PLEASE PRINT IN INK Massachusetts Electrical Code OR TYPE ALL INFO (MEC),527 CMR City or Town of: INFORMATION) MR 12.00 f Wires: By this application the v f� ) Date: ��, Location iinber) gives notice ofhis or her mtenhon to To the Ins (Street n Number) pector o Owner or Tenant /O.yt perform the electrical w k described below. Owner's Address Is this permit in con' Telephone No. function with a building permit? Purpose of Building P / Yes No ❑ Existing Service � (Check Appropriate Box) O D Amps /ZV/Z YO Utility Authorization No. New Service Volts Overhead ►-� / Amps / �i!/ Undgrd 0 No of Number of Feeders and Volts Overhead Meters L_ Location and Ampacity ❑ Undgrd Nature of Pro 0 No of Meters L v�ti Posed Electrical ical Work: No.of Recessed Luminaires Com=letion o the ollowin• table ma �-�No.of Luminaire Outlets f No.of CeiL_Sus be waived b the Ins o P (Paddle)Fans 0.o Wires. No.of Luminaires No.of Hot Tubs Transformers KVA minaires Generators No.of Receptacle Outlets 1- Swimming Pool :rill°Ve In_ KVA d. ❑ rnd. ❑ o.o mergency i ing of Switches �� No.of Oil Burners Batte Units g /0 No.of FIRE ALARMS No.of Zones No.of Ranges Gas Burners / O.o 1 etection an• No.of No.of Air Cond. ota Initiatin Waste Disposers Devices eat Tons No.of Alerting No.of Dishwashers Totals: KW j ons = �, Devices No.o el - No.ofD r Space/Area Heating Key Detection/Alernt,n1°ed Dryers _ Devices °•° "ater Heating A Local❑ unicipal Heaters Appliances KN, ecuri Connection 0 Other KW No.o tY stems: No.Hydromassa Silas �°•o No.of Devices or ge Bathtubs Ballasts Data Wiring: E•uivalent OTHER: No.of Motors No.of Devices or TotalE,uivalent HP e1No of Devices or Estimated Value of or E.wing: Electrical uivalent Work to Start: Work: O, �p� � ,' Attach additional detail z INSURANCE (When required b .rdesired, or the licensee E OV RAGE L Inspections to be requestedY munici as required by the providesUnless waived by in accordancepal policy) Inspector of Wires. undersigned proof of liability the owner with MEC Rule 10,and u gned certifies that such coverage i the on 'no Permit for the CHECK ONE: SU ge is in force,and ha "completed operation"performancec of its substantial on completion.equivalent. 4 I cernlY,under the RANGE ❑ BOND as exhibited coverage or its substantial e FIRM N pains and Proof of same to may issue Mess VD NAME: enalties ofper� OTHER 0 (Specify:) the permit issuingquivalent. The Licensee. h �` �'��(} t the information office. �IfaPPlicable, cl til��� ti mati on this application>s true and W Address: enter "exe G complete. '�'1't r the license rS Signature LIC. *Per M.G.L. c. �7 number!in •) NO.: �Z OWNER'S INSURANCE's•57-61,security � "`�/'ll,�- LIC.NO•: / Owner/Agent required Y law. B mysignature inWAIVER: a belo WI mork raware tuires D ph ment ofPub afe �/ �,�/ AltBus•T el.No.: l YJ gent ow,I herebyLicensee S License: eL No•: ��``J�j Signature waive this requirement.does not have the Lic• No. uirement. I amliability insurance Telephone IVo• the(check one ❑ownerc0Verage normally ❑owner's a:ent. PERMIT FEE: 5 7S C4a L / Official Use Only °•: Commonweal o f Official���,, Q / R E �,. Z4 1% D c� Permit No.�%72;3 I (P c =_ai -. JJepartment o f Dire�ervice.4 - =f�=F Occupancy and Fee Checked Jp v -=�!~2 •'' RD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] �iN a;, �9• (leave blank) i BUIU) NG LAPPIL - TION FOR PERMIT TO PERFORM ELECTRICAL WORK Br _—-t-- ' 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: 1/j;,/ a - z City or Town of: /��j�Qc//4 To the Inspector of Wires: By this application the undersig d gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 6 6 ft/OM,C/Ls U oeJC " Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building $jyf/ e �i 6, Utility Authorization No. Existing Service /p 0 Amps/ /ZD/2 YOVolts 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: ate/ ' c..,/,e .Gc„%'.F j b/„,.,v�, J AGt L l!//,v J ,00/vt 4, hri < Completion of the following table may be waived by the Inspector of Wires. Nootal No.of Recessed Luminaires J No.of Ceil: Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting Z grnd. grnd. Battery Units No.of Receptacle Outlets /f No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and /(� Initiating Devices Total No.of Ranges / No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers / Space/Area Heating KW Local❑ Municipal ❑ 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: f p. 90� o (When required by municipal policy.) Work to Start: CO i, 7 p 2 L Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE V RAGE: 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 Vi undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. v' CHECK ONE: 'INSURANCE ❑ BOND ❑ OTHER ❑ (Specify) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. O FIRM NAME:�q /7//c&C/ APES�/ h ir../1 LIC.NO.: �L 3�/- I Licensee St-ta„v v "A 4,eQ (/(S.S Signature LIC.NO.: 1 Li t n-4 (If applicable, enter "exempt"irf`the license/rob;ling.)• , L Bus.Tel.No.: 6!,)-,f 0/GJ?,f w Address: 2_ 6 &-lit(5 W 0 e ag"-- /141- ofaeO/ 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 ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 75-