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Home My WebLink AboutBLDE-22-000702 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-000702 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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•8/9/2021 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) 16 WILSON RD Owner or Tenant Arkady Goldenshtein 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 ❑ 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. TTotal No.of Alerting Devices n 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 ❑ 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 Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: Licensee: Matthew Kane Signature LIC.NO.: 55328 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:35 Harvard Street,South Yarmouth Ma 02664 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 eonrnwouusanh oif Maesaciaeeili Official Use Only c� Permit No. ��07 0 _- rel ..lie wt give�etwicN i P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: $ j al City or Town of: i at-moo-Ili To the Insp for of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) IC, w ,1 So n R8 S - UjcaM Pilo Q4-1-1 Owner or Tenant A c VN a a y �.o 1 C\e n S h -fie;C' Telephone No. Owner's Address U , Lot'1 So n ( 4- S• Y r t"h c)v't is this permit In conjunction with a building permit? Yes 0 No 0 (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters New Servib4 Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rep kacety e n A- b0 A p.- Completion of thefollowinktable may be waived by the Impactor of Wires. No.of Recessed Luminaires No.of Ceti.-Susp.(Paddle)Fans Tof ot TransnTransformersKVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Pool Above In- rto.oe Emergency Lighting No.of Luminaires Swimming grnd. ❑ arrnd. ❑ Batter,Units ( No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones y No.of Switches No.of Cu Burners 4 No.IniDtating H oDevices Total " No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Hest Pump Number Tons KW No.of Self-Contained Detectio&AlertlntlCDevices V No.of Dishwashers Space/Area Heating KW Loma[❑ Connection ❑ other tysa No.of Dryers Heating Appliances KW S�NNoo.of Deviccees�or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent N Telecommunications Wiring: 41 No.Hydromassages Bathtubs 1No.of Motors Total HP Na of Devices or Equivalent OTHER: -moi• Attach additional detail if desired or at required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) t Work to Start Inspections to be requested in accordance with MEC Rule 10,and upon completion. ‘s INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless V' 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 ❑ OTHER ❑ (Specify:) Q i certif f r,under the pains and penalties of perjury,that the Informed..,on this applkatian Is true and completes —.< FiRMNAME: ma f+ Kane Elec+'r,c LI-c. LIC.NO.: s53a2 (3 J Licensee: vie)a+-- H a rye_ signature w 2_ LIC.NO.: 5539 g >3 —1 (If applicable,enter"exempt"In the license number line) Bus.Tel.No.: 77 V-91`1- 7"c c Address: 35 Ha t vafd St- S. ' (•^ NnA o a 6 6 y 'Per M.O.L.c. 147,s.51.61,securitywork „ " Alt.Tel.N . requires Department of Public Safety 3 License: Lic.No. Z 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/Agent Signature Telephone No. PERMIT FEE: S