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HomeMy WebLinkAboutBLDE-21-005336 Commonwealth of Official Use Only If�:. Massachusetts Permit No. BLDE-21-005336 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:3/17/2021 To the City or Town of: YARMOUTH By this application the undersigned gives notice of his or her intention to perform the electrical work described below Inspector of Wires: Location(Street&Number) 67 BALSAM WAY Owner or Tenant QUIRK RICHARD M JR Owner's Address QUIRK NANCI L, 67 BALSAM WAY,YARMOUTH PORT, MA 02675 Telephone No. Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Existing Service Am s Utility Authorization No. P Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Wiring for in-law addition. 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 Transformers Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool In-gr Above ❑ ❑ No.of Emergency Lighting rnd. n- No.of Receptacle Outlets Battery Units No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiating Devices No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number J Tons I KW No.of Self-Contained Totals: l Detection/Alerting Devices ._ No.of Dishwashers Space/Area HeatingKW Local 0 Municipal 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water KW No.of No.of Devices or Equivalent HeatersNo.of 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 Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) 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 I certify,under the pains and penalties o OTHER 0 (Specify:) i © 31 FIRM NAME: fperJury,that the information on this application is true and complete. Licensee: Shawn Micheal Ricard Signature (Ifapplicable,enter"exempt"in the license number line.) LIC.NO.: 22895 Address:27 Baywood Drive, Orleans MA 02653 Bus.Tel.No.: 7748012921*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normallyrequired 9by law.But signature below,I hereby waive this requirement.I am the(check one) qu�red by law.But ❑ owner 0owner's agent. Signature Telephone No. PERMIT FEE:$80.00 ?OuCo f 3112 f z ;61 Md St4Cmunoniveaah oi Maataektooth Official use only it .wt a ..tine�.,wi... permit No. �Zl -�J�J� Y _ .,`V BOARD OF FIRE PREVENTION REGULATIONS [��vy and Fee Checked (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: 3-/5- 1 Cfty or Town of: rarr"o& To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to Location(Street Si Number) perform the electrical work described below. ((? Owner or Tenant R.1 cl„ �n�� K ��� r. c>7 Owner's Address Telephone No. F Is this permit in conjunction with a building permit? Yes Fri No ❑ (Check en-';t� Appropriate Box) Purpose of Building Pes sc9 Existing Service Amps Authorization No. Amps / Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampac ty El U°dI 0rd No.of Meters Location and Nature of Proposed Electrical Work: i i e n C'r" Nc9df r{'i oA Completion of the followiri; table inv+be waived by the/14, No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans o.of VA°f Wires. formers No.of Luminaire Outlets No.of Hot Tubs Generators KVA : No.of Luminaires Swimming Pool Above ❑ In- ro.of Emergency '*" No.of Receptacle Outlets � �d' ' ,d• ❑ Batt: Units g ` No.of Oil Burners FIRE ALARMS No.of Zones - No.of Switches No.of Gas Burners o.o r"�"� n a, , Na of Ranges I " Devices No.of Mr Coed. Tons No.of Alerting Devices No.of Waste Disposers . ` a ' L 'o.o -..; Totals. Detectiont/ .on Devices No.of Dishwashers Space/Area Heating KW nnec Local" Co a ti ❑ Other No.of Dryers Heating Appliances ":'T' :or Heaters KW o.o 'o.o .< or , a,t a,s Ballasts Data No.o Wiring:No.Hydromassage Bathtubs No.of Motors t Tote!HP , ,1 nr -; ... , ;, OTHER: No.of Devices or , t Estimated Value of Electrical Work: Attach additional detail if desir or as rn tired by the Inspector of Wires.work to start:-3_/�-� (Whensquired by municipal Policy) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no the licensee provides proof of liability insurance inc "completed 1 for the prfarnatrce of electrical work may issue unless signed certifies that such coverage is in force,and has operation" or its substantial equivalent The CHECK ONE: INSURANCE proof of same to the permit issuing office. I ct>#f',under the andpe❑naigj ofperjary,that the inOTHER 0 formation ) FIRM NAME: �' hoar on this application is true and caste Licensee: Vl��. � �"`' LIC.NO: Ile.�a�y — I C Q Sigoatnre../�'�of icable,enter exempt ►n the license LIC.NO.: 55 3� Address: "umber line.) f� a,c aS��I �rl e era 36. Bus.Tel.No.: *Per M.G.L.c. 147,s S 7-61, Ask Tel.No.: OWNER'S INSURANCE WAIVER. lamrequues Department of Public Safety"S"License: Lic.No. requiredOWNS by law. R mysignatureaware that the Licensee does not have the liability insurance cov e Owner/Agent below.I hereby waive this requirement. I am the(check one normally Signature ■ owner ■ owner's .:eat. Telephone No. PERMIT FEE: �i