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HomeMy WebLinkAboutBLDE-22-002821 Commonwealth of Official Use Only f� Massachusetts Permit No. BLDE-22-002821 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:11/16/2021 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) 38 EVERGREEN ST Owner or Tenant CHESSON HAROLD R III Telephone No. Owner's Address CHESSON CHERYL J, 116 OAKWOOD DR, EAST BROOKFIELD, MA 01515 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: Wiring of 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 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 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 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/Alertine 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 Ballasts Data Wiring: Heaters Siens 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: JULIUS PRIZGINTAS Licensee: Julius Prizgintas Signature LIC.NO.: 20442 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:97 CHUCKLES WAY, MARSTONS MLS MA 026481583 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. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 O "( 17(a-k (ei 4. 7\561" at1312f e CDt- o Official Use OnlyCommonwea00th adeac� °=_ ,„ Permit No. �L2Zg�' nL R,Zt/ .* Zepartment o/ }tie serviced a h II F a ';,, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 1/07] leave blank re - m° i ' PPLICATION FOR PERMIT TO PERFORM T© All work to be performed in accordance with the Massachusetts Electrical Code(ELECTRICAL WORK ' EASE PRINT IN INK OR TYPE ALL INFORMATION) . ' City or Town of: Date: �f//f? ®�/ YARMOUTH To the Inspector of Wires: a' By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) '�+ � Owner or Tenant �� ��� ��6� Owner's Address G 5 O Telephone No. Is this permit in conjunction with a building permit? y� a � NO ❑ (Check Appropriate Box) Purpose of Building 1&.,' Existin Service Utihity Authorization No. g Amps`?a_ i2fO Volts Overhead Er Und rdNew rvice Amps / g ❑ No.of MetersNumber of Feeders and AmpacityVolts Overhead❑ Undgrd❑ No.of Meters Location and Nature of Proposed Electrical Work: io fU r; No.of Recessedtri Completion o the ollowin,table m be waived b the Ins.ector o Wires. ev Luminaires No.of Cell:Sas . `°,o No.of Luminaire Outletsp (Paddle)Fans ota r� No.of Hot Tubs Transformers gVA i" No.of Luminaires Generators KVA Swimming Pool ,rI o e ❑ •n- 0 'o.o mergency g ng No.of Receptacle Outlets °d Bette Units g No.of Oil Burners FIRE ALARMS No.of Zones • '-- No.of Switches No.of Gas Burners `o.o t etec on an 1 No.of Ranges No.of Mr Cond. IniHatln Devices ota No.of Waste Disposers Tons No.of Alerting Devices eat 'ump `um er ons ' " `o,o e onta ne Totals: Detection/Alertin. Devices No.of Dishwashers Space/Area Heating KW 'un c a No.of Dryers Heating Appliances Local 0 Connection 0 Other' W `o.o "a er K ecu ty ystems: Heaters KW `o.o No.of Devices or E uivalent °'° Data Wiring: Si ns Ballasts No.Hydromassage Bathtubs No.of Devices or E i uivalent No.of Motors Total HP a ecommun ca•ons " ,g• OTHER: No.of Devices or E•uivalent Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) INSURANCE COVE Inspections to be requested in accordance with MEC Rule 10,and upon completion. RAGE: Unless waived by the OCT,wn 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. undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE9 nt. The I certify,under the pains and penalties Oo D 0 OTHER 0 (Specify:) (kl�Z' f y:) FIRM NAME: �p jperfury,that the information on this application is true and complete. �Cy4HJc',dC per, a -r L e G LIC.NO.: _1 Licensee: j (If applicable,enter••exem t"in th cease number line. Signature Signature Address: �' vl,.�JrS LIC.NO.: *Per M.G.L.c 147 s 57-61,security work requires De ITO �� Bus.Tel.No.: p/AX OWNER'S INSURANCE WAIVER: Pertment of Public SafetyMt.se: Lic.No.TeL No.: OWN by law. By my signature I am aware that the Licensee does trot havehe liability am the(check one insurance overage normally Owner/Agentrequir below,I hereby waive this requirement, I Signature / owner ■ owner's a:ent. Telephone No. PERMIT FEE:$