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HomeMy WebLinkAboutBLDE-20-005501 Commonwealth of Official Use Only �_.` i Massachusetts Permit No. BLDE-20-005501 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:4/21/2020 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) 52 SEMINOLE DR ! ` l ekt A-(! L_ p--- -/L0 UL--0 Owner or Tenant ROMANO BERNADETTE A Telephone No. Owner's Address ROMANO ROBERT T, 22 REDWOOD RD, NEW HYDE PARK, NY 11040 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 o.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ eters Number of Feeders and Ampacity ��I Location and Nature of Proposed Electrical Work: Remodel house. Completion of the following lA .vat, ,,, . of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of '� a Transformers • A No.of Luminaire Outlets No.of Hot Tubs Generators , . A t i No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting ' grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ,' 21 e No.of Switches No.of Gas Burners No.of Detection and Y 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/Alerting 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: TYLER W PAYNE Licensee: Tyler W Payne Signature LIC.NO.: 22091 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:5 JANS PATH, HARWICH MA 026452458 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: $75.00 u , 1(/7i(2-0 G Commonwealth of Massachusetts Official Use Only II Permit No. �Z S``a T # � Department of Fire Services c E' -=-:-..t= Occupancy and Fee Checked 'J`tip -`T``- BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 V •� (leave blank) 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 INFOR TI N) Date: ,)\\_ e-0 To the Inspector of Wires: ''' C City or Town of: 4myx\o..34Ky\ the electrical work described below, 'J By this application the undersigned givece of his or her intention to perform Location(Street&Number) 52 Ci'n n 0 I e Dr u Owner or Tenant IV IC}Mel [ e)10 U Telephone No.��(t-�',7 t7. Qz- Owner's Address 7. SP,YY1\Klc� VX" ) I i�---- &„. Is this permit in conjunction w th a building.permit? Yes ❑ No ❑ (Check Ap{ 17, Purpose of Building C. W.,'��1�. Utility Authorization Noy ��ppDD 8 ! Existing Servic Amps )�I ego vats Overhead 0 Undgr.- No of!Vleetars2,12 ?Q C..) New Service Amps / Volts Overhead❑ Undgrd 0 Noreefe>rs --LDIi� ; Ut=PT. N ay Number of Feeders and Ampacity yin Location and Nature of Proposed Electrical Work: ' \ 1 VQ1 1 IlST 3 ,..... Completion of the followingiable may be waived by the 1, ector of Wires. No.of Total No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd, ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons ---- Heat Pump I Number I r i Tons I KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local 0 Connection ❑ Heating Appliances Kms, Security Systems:* No.of Dryers No.of Devices or Equivalent No.of WaterKms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Dev •• or Equivalent n Telecommun VJ No.Hydromassage Bathtubs No.of Motors Total HP No.of I • Web + . tV v• r' --- OTHER: #'T9D = ,.a_ lO Attach additional detail if desired,or as r.yuired b�,/ i ns.ector e Estimated Value of Electrica Work: (When required by municipal policy.)I �' .� R i V .)/)21 / ' Work to Start: kQ Inspections to be requested in accordance with MEC Rule 1��Ipp89-comple on. ye/ INSURANCE CO R GE: Unless waived by the owner,no permit for the performance of elecfrical wot Mr,'.' -^unless cS the licensee provides proof of liability insurance including"completed operation"coverage or its substan r. .le t. 'l"I>e+; undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. t :>-- CHECK ONE: INSURANCE ] BOND' ❑ OTHER ❑ (Specify:) l"t'- I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:PM/IV)E €L.ecrgALt (N C. LIC.NO.5 C) Licensee:—ri LI 4 W, Pt°r'Yt..sv Signature I. /#1,���'7 LIC.NO.:2� 1- (If applicahl enter"exempt"in the license number line.) / Bus.Tel.No."T7'1:2©r'1.7u'1L10 Address:.b JA'N‘S IC'l'V(.i I.. 0 , Alt.Tel.No.r774 x.12. /12, *Security System Contractor License required for this work;if applicable,enter the license number here: 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 PERMIT FEE:$ Signature Telephone No.