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HomeMy WebLinkAboutBLDE-21-006283 \tib Commonwealth of Official Use Only Permit No. BLDE-21-006283 0,41, Massachusetts ly 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:4/30/2021 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) 36 RUSSELL LN Owner or Tenant RUSSELL RICHARD J Telephone No. Owner's Address 36 RUSSELL LN,WEST YARMOUTH, MA 02673 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: Remodel basement. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 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 grnd. grnd. Battery Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 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 Totals: Detection/Alertine 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 Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiri No.of Devices or Equiv, i �� OTHER: Attach additional detail if desir ,or'• equired by .•*2. for of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) 9y 9/4) Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon comp , oo 4 c;)U INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unles`u e r.:.see A �, provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned ce\ es 1�s suc r coverage is in force,and has exhibited proof of same to the permit issuing office. ©cc' CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) ,oT I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 r a k Uthff s'A I 12-( ee- V \ L 1 I 9) itl, eceruneasseak 4 Massacksistis Official Use Only y • ., � ar�esaraE O tte�ei Permit No. a.2---A (P 7---9---; ieerd 1/411/4 • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1H171 ( blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Maw Elc�ical Code(MEC),527 CMR t 2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ()fi, go 1 9,o a I City or Town of: y G ,rnwrd 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 4:Number) ,, ! „ ., 7-4 Owner or Tenant . ' t- S�k I Telephone No. • — 4io'�. 1 Owner's Address il?`O `'wS ce,ki (py►ez1,A),LecVeVULrhlr (vIA 026.-73 Is this permit in conjunction with a building permit? Yes ,® No 0 (Check Appropriate Box) Purpose of Building; 5 it Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 53 No.of Meters g. New Service ' Amps / Vohs Overhead 0 Undgrd p No.of Meters .2___ Number of Feeders and Ampadty Location and Nature of Proposed Metrical Work: eck4 crew f`Cr fk.f.v.S /C'J fr i `¢1),M Comet ofdee followinttabk nay be waived 60 the Inspector of Wires. vi Tatar IA No.of Recessed Luminaires (1 O No.of CA.-Snap.(Paddle)Fans T of r KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- No.at-Emergency Ligating k No.of Lumiusires Swimming Pool p'd, ❑ ❑ ger!Units No.of Receptacle Outlets ' No.of Oil Burners FIRE ALARMS No.of Zones Detection and No.of Switches , No.of Gas Burners `No.Initiating 1 kJ No.of Ranges No.of Air Cond. T No.of Alerting Devices No.of Waste Disposers otal Hat Pump Numler Teas KW No.of Self-contained Toho: Detection , ,, . Devices No.of Dishwashers Space/Area Heating KW Local 0 M ' "w` 0 Other R No.of Dryers Heating Appliances KW of=or Euuivsleat No.of Water KWNo.of No.of Data Wig: Heaters Sips Ballasts No.of Devices or -' No.Hydroma Bathtubs No.of Motors Total HP To. Motor E9aiv OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start '�,—(pp TWA S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGEO 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 0 (Specify:) I cetsljy,under the pains and penalties ofperjaury,that the Mfonnation on this application is true and complete. FIRM NAME: LIC.NO.: LOensee: Signature LIC.NO.: (lfapplicabk,enter"exempt"in the license number line.) Bus.Tel.No.: Address: Alk 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 y my signature below,I hereby waive this requirement. I am the(check one owner owner's a t. Own Signature Telephone No76 I --4))91-1:19' ERMIT FEE:$ r