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HomeMy WebLinkAboutBLDE-20-006062 • I! 6 oil 4 Official Use Only . fin BLDE-20-006062 " Permit No. 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:6/3/2020 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) 62 LUMBERJACK TRAIL Owner or Tenant SIMPSON EDWARD J JR Telephone No. Owner's Address SIMPSON JANE L, 62 LUMBERJACK TRAIL,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: Permit to close out ex•ired •ermit ` :7:717,1-'7,10::::;11,."="7:7;1„.2'3a__It.. Completion of the following table m,, .7 , by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Twn..oF 0 Yt7A No.of Luminaire Outlets No.of Hot Tubs Genera AboveIn- No.of Emerge No.of Luminaires Swimming Pool o o g pi4,,,r7:„ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.o No.of Switches No.of Gas Burners No.of Detection and ey,, 4 No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons f KW No.of Self-Contained T..*..lo. rlo*o..*:..../A low*:....111.wi.00 No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: r,.....ti.+:11.11 No.of Dryers Heating Appliances KW Security Systems:* N.. ..f no.,:..00.,w T.,..:....1....* No.of Water KW No.of No.of Ballasts Data Wiring: po..*o..e c:....r N.. ,.F nIll,:..o0 AD.c,...:....10..f No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: N,. ..F lln.,:nno..w C,...:o..lo..* 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: 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: $50.00 qe.., 03(-2.4 Kt C4-/f__ rr -t1Lr-- E-iii& Official Use Only 1 14Co,n,no,�.a�ojm, l �2e-0o6v i c� c7 Permit No. • ;.' - .Uapartinant o` tint&awicaa • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] peeve 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 INFORMATION) Date: (. 111 20 City or Town of: '/Ii•stR VYl U U A l-A 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) Cc I---U tmk> a e.I.Tvz.t t Owner or Tenant Peicr I S M i r t U o l , S PA Mi-• Telephone No. 74Si-56,3-03g r( Owner's Address 5 cum e Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building ervval-e,1-4ome Utility Authorization No. Existing Service loo Amps I Z-0 / 2_,40 Volts Overhead❑ Undgrd© No.of Meters I New Service c Amps / Volts Overhead❑ Undgrd ia No.of Meters I Number of Feeders and Ampacity (%f ) c S cl(-,-4-419 Location and Nature of Proposed Electrical Work: a,}(.e fs l %i i-c(A.eA , 3,r - ay-O V -e CC-oe, bAS,e10061Ad 5 Completion of the foiowin table may be waived by the/ for of Wires. No.of Recessed Luminaires No.of Cel.-Susp.(Paddle)Fans To. s Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaire: 3 cz,1. � Swimming Pool Above ❑ In- ❑ Bate Emergency Lighting - "� grad. g`rnd. Battery Units No.of Receptacle Outlets I'7 No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches rs No.of Gas BurneNo.of Detection and Initiating Devices No.of Ranges No.of Air Coad. Tun l No.of Alerting Devices Heat Pump Num _ ber Tops KW 'No..of Self-Contained No.of Waste Disposers Totals: "- "` `.�. Detection/Ale Devices 9M No.of Dishwashers Space/Area Heating KW 4500D SF Local 0 Cyonnecanici tion 0 Other No.of Dryers Heating Appliances dL KW g SecurNo. f uevices or Equivalent No.of Water , No.of No.of Data Vy�ng• Heaters Signs Ballasts No.of Devices or Equivalenti� No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications al Noomm.of Devices or Wiring: Equivalent OTHER: 19RE\(1ou5 PE2alcr E?PIKED. REIAD I Fog- Fj$IA� a. 1NSPEGT1 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: I I 40 19 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 0 (Specify:) I cenGify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: 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: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. Bymysi: • i I herebywaive thisrequirement. I am the(check � +, one) owner owner's agent. Owner/A eat ��� Signature � - Telephone No. -1St-5I 6-03 91 PERMIT FEE: $ .-O. �.w4. . The Commonwealth of Massachusetts It -,l ►_Ef Department of industrial Accidents =:ge= p 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMI I'riNG AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): PETL— 3- .Vv\t-r1.1 Address: a Lu vv\6 ES-ac ,j,2.A-1(.., City/State/Zip: \A1 Y Rw'c o 7-1/,SIA 0,lo 73 Phone#: -79i- 51, s -6 3 9 7 IAre you an employer?Check the appropriate box: 11 •-r;pc.,f,,....;o,.t •t.n....i