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Home My WebLink AboutBLDE-22-004336 01:11o. Commonwealth of Official Use Only 1 ' Massachusetts Permit No. BLDE-22-004336 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) City or Town of: YARMOUTH Date: /4/2022 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) 33 CHAMBERLAIN CT Owner or Tenant NIMIROSKI CHERYL A Owner's Address PO BOX 365,ATTLEBORO, MA 02703-0007 Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Utility Authorization No. Existing Service 200 Amps P Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Replacement of damaged exterior service. METER#:2286258 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 Above grad. ❑ In- CINo.of Emergency Lighting grnd. Battery Units No.of Receptacle Outlets 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 Toni No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Municipal Local 0 P 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water KW No.of No.of Devices or Equivalent HeatersNo. No.of Ballasts Data Wiring: SigNo.Hydromassage Bathtubs No.of Devices or Eauivalent 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 OTHER 0 I certify,under the pains and penalties of perjury, er u that the information on this application is true and complete. FIRM NAME: Michael D Hollister Licensee: Michael D Hollister (If applicable,enter'exempt"in the license number line.) Signature Tel. NO.: 10071 Address:85 N DENNIS RD,S YARMOUTH MA 026641017 Bus.Tel.No.: 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. Signature Telephone No. PERMIT FEE:$50.00 t` /7/2� Cam.. . RECEIVED CR4' FEB 03 2022 4=sb w BUILDING U . • Commonwealth f Madsac tt3 BY' P J O �-•.- _filly__� c� Official USe,t�nly -tf=•` apartment of Jarvicts Permit Note— ("---' I BOARD OF FIRE PREVENTION REGULATIONS ''-= Occupancy and Fee Checked 1 'ev. 1/07] eave blank --' All work to be performed in accordance with the Massa husetts PERFORM-Electrical ELECTRICAL C), WORK (PLEASE PRINT IN INK OR TYPE (MEc),527 1 z.00 $ City or Town of: AR1VI0 TH) To the Date: y this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) described Owner or Tenant kt S / (Z Ts Address t riiCu Telephone No. 2� I Is this e �jZ permit in conjunction with a building permit? Purpose of Building � Cc- Yes ❑ No (Check A ro Hate Box) PP P Existing Service Utility Authorization No. 's �C Amps ! Il0 Volts Overhead2 Und d New Service Amps / � ❑ No.of Meters Number of F —Volts Overhead❑ Undgrd ❑ No,of Meters eeders and Ampacity n g _ Location and Nature of Proposed EIectric ( �t C : Qy� e47--t. sI Work No.of Recessed Luminaires Completion o the ollowin- table m. No.of CeiL-S be waived. the Inspector ojl Wires. No. of Lumi atsP (Paddle)Fans No,of Total Haire Outlets No.of Hot Tubs Transformers KVA Generators KVA No.of Luminairesg S wan Pool Above�rnd ❑ In_arrrd ❑ gatte Units No. of Receptacle Outlets mergency ' 'tang No.of Oil Burners No. IMEMI of Switches No,of Zones No.of Gas Burners `o.of Detection No.of Ranges and No. of Air Cond. Initiating Devices No.of Waste D' Tons No.of AlertinDevices Disposers Heat Pump umber Tons No.of Dishwashers Totals: ----- lin Deo.t of elf-Container Local of. Devices Space/Area Heating KW No.of Dryers Local[i Municipal Heating Appliances Connection ❑ Sher No. of ater KW Security Systems:* Heaters KW No.o No.of Devices or E.trivalent Si. s ° of Data Wiring: No. Hydromassage Bathtubs Ballasts No.of Motors No.of Devices or E.uivalent OTHER: Total HP Telecommunications Wiring: Na.of Devices or E.uivalent Estimated Value of Elec 'cal W Attach additional detail t d Work to Start: Work d G (When f wired or as required by the Inspector of Wires. ZZ Inspections to be requested in accordancec byuired municipal Rule INSURANCE C VERAGE: Unless waived by � the licensee provides proof E. a in the owner,no e MEC Rule 10, cnd upon completion.mayss the licinsedpovi certifies that such coveragef a insurance including"completedP redo for the n"coverag e r electrical wore ui x operation"sameoverhge er its substantial equivalente unless CHECK ONE: INSURANCE force,and has exhibited proof of to the I certify, under the pains and BOND 0 OTHER 0 (Specify:) Permit issuing office. FIRM NAME: penalties ofperJury,that the information n I e 46:e_ f anon on this application is Due and complete Licensee: I L, -/ !� T —� (If applicable,enter "exempt" Signature LIC.NO.: GYJ 7 f ^ ? Address in the license number lin -1 'Per WERG�L. c. 147, Pr, security work re Bus. LIC.NO.: S INSURANCE s.57-61, Tel.No.: • RANGE WAIVER: quires Departure t of Public Safe Ait.Tel, o.- 1 required ' law. I am aware that the Licensee does not have„Lliabiii Owner/Agent By my signature below I herebyLic. No. I Si waive this requirement I the liability Insurance coverage gnatnream the(check one ❑ normally Telephone No. owner ❑owner's a eat PERItrrT r•r,. - r-o.