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Home My WebLink AboutBLDE-21-004171 ''' Commonwealth of Official Use Only 14V---- Massachusetts Permit No. BLDE-21-004171 4,.— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] Li 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:1/26/2021 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) 192 SOUTH SHORE DR UNIT E Owner or Tenant Horizon Engagement Telephone No. Owner's Address SOUTH YARMOUTH, MA 02664 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: Remodel ROOM#54 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 2 Swimming Pool Above ❑ In- No.of Emergency Lighting grnd. l rnd• Battery Units No.of Receptacle Outlets 10 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 �,,,bf 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 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: Michael S Walsh Licensee: Michael S Walsh Signature LIC.NO.: 51043 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:36 BOSUNS WAY, MARSTONS MLS MA 026481015 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 lure Telephone No. PERMIT FEE:$100.00 i.jra1 3 ((c1(2A V ti Commonwealth.oassac use/ h tts Official Use Only �� , J� _ ( *_; Permit No. _"' IC '`7l —_A` Thepartm4nt o f Sire Services 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: \ 'M i Z City or Town of: y 0,c Nwu k1n 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) 1 cm S. Sko r t Or k)IN ‘4- i S 14 Owner or Tenant P d r 120 n f.nebtte t4t"A- Telephone No. Owner's Address S p.'e. Is this permit in conjunction with a buildin permit? Yes dr....No ❑ (Check Appropriate Box) Purpose of Building 4{0l44 , P. Utility Authorization No. Existing Service too Amps MO /Z t Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: .LA 1 a r -L •o M , M c. to.."Z Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets `C) No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and 3 Initiating Devices No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices 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 Other 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:e`B.p ^tiukC cL rzo or to y { r ? r C' . D Attach adcfitional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: OW (When required by municipal policy.) Work to Start: I lib/ Zl Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO ERAGE: 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 V" BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: k,I S Ue,�+S „ �1(r; — LIC.NO.: 5 I 0 T5 E Licensee: IA:c S Signature "l (egeiht f LIC.NO.: 5 1 0 3 E. (If applicable,enter "exempt"in the license nu er line.) Bus.Tel.No.: •C. rotC Address: d ��( 13 to A (. � GZG Y g Alt.Tel.No.: a 6 33•�o!R *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. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $