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Home My WebLink AboutBLDE-21-006299 Commonwealth of Official Use Only :1- Massachusetts Permit No. BLDE-21-006299 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 pertorm'fhe electrical work described below. Location(Street&Number) 9 DOVES WING RD Owner or Tenant FIJOL JOHN J Telephone No. Owner's Address FIJOL SHERYL J, 19 WADSWORTH RD, SHREWSBURY, MA 01545 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: Add additional receptacle& modify existing circuit. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 2 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 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and 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: 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 lephone No. PERMIT FEE: $75.00 r-, //dd``(( i '- " til m Official Use Only ..,------„........_ r .r Commonaleakh.of 41a,mac .._� k... `se / !-`� ., c� Peftnit No. E �9 I T_-SIN w 2apartmsnf of airs 3 �'±1.1 2 2 ' I i.,' Occupancy and Fee Checked ,r BOARD OF FIRE PREVENTION R LATIONS___[Rev. 1/07] (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 INFORMATION) Date: 'a/ 7/ i i 4:11° City or Town of: y5 r yr,C;,:,i 4 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ie Location(Street&Number) J 9 v�� c�.�y � 2�.0 IOwner or Tenant .3(51,,„ F; 3 Telephone No. e- 71-'`f-30Y,j' 1 Owner's Address /5 4)_«,Lsc✓orti /2, , ,S 4,re 4J5.17,_jr1' "nil cis y.5-- CSI. Is this permit in conjunction with a¢uiiiding permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building adz) 9" Floor- iner�Kr 13cz fl. Utility Authorization No. �( Existing Service Amps / Volts Overhead❑ Undgrd E No.of Meters 0' New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity e%t(al.-, e-_,yc : V4.,p SetvvcC. cs.i CPT e?✓t/c-T Alai: ex.Sf'pfr Location and Nature of Proposed Electrical' ork: z_,)Li frO7 eA-0,'1 _c e_ r„tif-c:cLie dj4e,,rip o, Vg: Completion of the following table may be waived by the Inspector of Wires. v� No.or Total lb No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)FansT. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA rv` Above In- No.of Emergency Lighting A: No.of Luminaires / Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS No.of Zones of Z No.of Switches 3 No.of Gas Burners No. Initiatinnggon Dete and In Devices I'+.' No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Di Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Secus:* rity m of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: No. H y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: , .//Oct? (When required by municipal policy.) Work to Start: 4p I c)2 1 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 certify, 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 INSU: - .E WAI . I am aware that the Licensee does not have the liability insurance coverage normally required by In . By m sign re below,I hereby waive this requirement. I am the(check one),K1 owner ❑owner's agent. Owner/Age t Telephone No. _, d'-1 v`l Signature p PERMIT FEE: $ 7 .aci G