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HomeMy WebLinkAboutBLDE-22-004480 Ri? Commonwealth of Official Use Only �� Massachusetts Permit No. BLDE-22-004480 ` 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:2/11/2022 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) 20 FORTUNE RD Owner or Tenant Jonathan Rubin Telephone No. Owner's Address 20 FORTUNE RD,YARMOUTH PORT, MA 02675 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: Addition Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 4 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tootal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 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: Hegtcrs Signs 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 DONOVAN Licensee: Michael Donovan Signature LIC.NO.: 15197 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:71 OLD MAIN ST, WEST DENNIS MA 026702224 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 %..ti c .,.(1 2/, f reg._ 41ice- 3AI/2)7 - ComiwnwsaCth of///a6sac ffd • Official Use Onl1.y __I. - —_ , -- -FSo _=_. ,,-__� c-� n �f=z Apart-meta o/.lira�7 Permit No. • Serviced -r -• Occupancy and Fee Checked >-:,� — BOARD OF FIRE PREVENTION REGULATIONS {Rev. I/07] (leave blank) _A Pr.'" Ir►.n:rin:►=trr+r, rE -.I. ._ _ PErr'QRj tLtC _KCAL 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: City or Town of: YARMOUTH To the Inspector of Wires: By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. • Location (Street&Number) a (5 •F p r4 U n e 1L C ) Owner or Tenant ©��k�c.n. \COb l ( Telephone No. Owner's Address S en v" Is this permit in conjunction with a building permit? Yes k No • ❑ (Check Appropriate Box) Purpose of Building ()o t A-t O ^ Utility Authorization No. N A.-- Existing Service,2tt),n Amps V2f) / 2.-,`•(0.-Volts Overhead ❑ Undgrd e--------No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires L. No.of CeiL Susp.(Paddle)Fans No.of Total �l Transformers I{VA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- "No.of Emergency Lighting grnd. arnd_ Battery Units No. of Receptacle Outlets 0 No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Total Initiating Devices No.of Ranges — No_ of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons H KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Q Municipal Connection ❑ otter. No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent No.of Heaters ' Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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: Inspections 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 ❑ OTHER ❑ (Specify:) I certzfy, under the pains and penalties of perjury,that the information this a plication is true and complete. FIRM NAME: I a_ © ©‘.3 c(-1 LIC.NO.' /47 rE Licensee: ___6.1 c. Q / c-- 1 o ,^ Signature (If applicable,enter exempt in the license number ire.) LIC.NO.: Address-. Q( u Bus.Tel.No.: J "Per M.G.L. c. 147, s-57-61,security work requires DepartmentL/f c Gy 0 Alt.Tel.No.c. No.: S"License: OWNER'S INSURANCE WAIVER: I am ware that thcensee does not Safhave the liability insurance coverage normally Srequired by law. Owner/Agent By my signature below,I hereby waive this requirement. Ellam the(check one ❑owner owner's a ent 0.1 Signature Telephone No. PERMIT FEE: $