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HomeMy WebLinkAboutBLDE-22-006795 , Commonwealth of Official Use Only E It k Massachusetts Permit No. BLDE-22-006795 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:5/24/2022 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. Location(Street&Number) 26 GENEVA RD Owner or Tenant Sue Canterbury Telephone No. Owner's Address 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 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 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/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 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: Michael D Hollister Licensee: Michael D Hollister Signature LIC.NO.: 10071 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:85 N DENNIS RD, S YARMOUTH MA 026641017 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 „, RE_CFI ED al,o •ah of Illatioachuootio Official Use(N _fit;:=� Permit Ne22 (o �.s . .F F1 MAY 2 3 201 )? id o`� S'.w ire k a Hil 40 Occupancy and Fee Checked \ ' gUI ,R FFTl 7R VENTION REGULATIONS [Rev. l/07] (leave blank) J A- - • • ` • — - ERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 C R 12.00 A (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S/Z ZZ City or Town of: YARMOUTH To the Inspector of ires: k` By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 1< Location(Street&Number) , (7 '/ v l * c VA L zv7 t-t Owner or Tenant S v 6- C A,,,t'�t S, 1,u�.i I' Telephone No. 7 7q Z 12 ZZ(98 Owner's Address Is this permit in conjunction with a building permit? Yes 0 No a (Check Appropriate Box) N , Purpose of Building � ��C� �S Utility Authorization No.r Existing Service/ I Amps i, / gyp Volts Overhead El Undgrd El No.of Meters 4 JNew Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters (11 Number of Feeders and Ampacity (j► e 0144 1 I ) r i(C a—. t4 i Location and Nature of Proposed Electrical Work: a, t/) Completion of thefollowinntable may be waived by the Inspector of Wires. CLF No.of Recessed Luminaires No.of Ce11:Sasp.(Paddle)Fans No.of Total J cv, Transformers KVA '1 4 No.of Luminaire Outlets No.of Hot Tubs Generators KVA _ Wit” No.of Luminaires SwimmingPool Above In- ❑ No.of Emergency Lighting U grnd. ❑ g nd. Battery Units of No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detecti= No.of Switches No.of Gas Burners No. Initiatin Devices 1'r 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 Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: III Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electr' al Work: 5 v (When required by municipal policy.) Work to Stan: 2 '22 inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVE 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Fr BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,ithat the information on this application is true and complete. FIRM NAME:_AA.1Ct%Ft6t. 140uiS'7r1 LIC.NO.: J6i©7 ►- 8 Licensee: lit.k\‘C__& Signature 1.-- LIC.NO.: (If applicable,enter"exem t"'n the license n mb line.) Address: r y Bus.Tel.No.: �7tP 5 �Ald►I S a , '� U1�i� Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Deparn4t 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 check one requirement. I am the Owner/Agent ( )0 owner 0 owner's agent. Signature Telephone No. I PERMIT FEE:$ � ) l