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HomeMy WebLinkAboutBLDE-21-005004 , '` ►, j Commonwealth of Official Use Only 11 Massachusetts Permit No. BLDE-21-005004 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:3/5/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 76 EVERGREEN ST Owner or Tenant ARPINO DOMINIC F TR Telephone No. Owner's Address ARPINO FAMILY REALTY TRUST,206 ROCK ST APT M8, NORWOOD, MA 02062-4904 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: Bedroom&bathroom 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 10 No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches 5 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection 0 Other: No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devics 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 I certify,under the pains and penalties of perjury, f erry,u that the information on this application is true and complete. FIRM NAME: Joseph M Jackson Licensee: Joseph M Jackson Signature Tel. NO.: 40012 (If applicable,enter"exempt"in the license number line.) Address: 125 DEPOT ST, SOUTH EASTON MA 023751539 Bus.Tel.No.: *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 normally required by law.But signature below,I hereby waive this requirement.I am the(check one Owner/Agent ) 0 owner 0 owner's agent. Signature Telephone No. PERMIT FEE:$75.00 c -0t 1 3/9Z-/7I L- _ -1 A84t /i€/72. Kee Commonwealth of,MaM4cturulls Official Use Only 'N �` P°'f'"'"i Permit No. - —` L� '!... • ol.lira services it ' Occupancy and Fee Checked .' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) ''! APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK a All work to be performed in accordance with the Massachusetts Elecsrical Code(MEC).527 CMR 12.00 • (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / '9r?ci4 3, D 2 l City or Town of: SouAN Ya.4,1►01.71r.•, To the Inspector of Wires: �r`,� By this application the tmdersigned gives notice of his or her intention to perform the electrical work described below. �,,1 Location(Street&Number)_7b tUr re�t..ct,n, S.-k- g cOwner or Tenant D nen An COI"CI Telephone No. 7TY•,.5-4i-/?lb L Owner's Address 7 b 4tlrr6 rc_e n 54. -13 Is this permit In conjunction with a building permit? Yes t No 0 (Check Appropriate Box) Purpose of Building 410 op r Utility Authorization No. Existing Service /DO Amps /.,)/1 gO Volts Overhead( Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters 1 Number of Feeders and Aapadty Location and Nature of Proposed Electrical Work: 2 1 1 v�i Completion of the followie table m be waived by the InspectorWirer.ctor of . W No.of Recessed Luminaires No.of Cell.-Sasp,(Paddle)Fans No.of% Total Transformers KVA CNo.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming psi Above ❑ In- ❑ No.of Emergency Lighting tend. grnd. Battery Units No.of Receptacle Outlets /rj No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.I fQonV+des i i-' No.of Ranges 1No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposer Heat Itnmp Number Ton -'s No.of Self-Contained Totals: ' �'� (DetecliodAletrting Devices No.of Dishwashers Space/Area Heating KW LMConnectionnk(pan 0 Otimer r - 0 No.of Dryers / Heating Appliances KW Security Systems: No.of No.of Water KW No.of No.of Data Wiring:ters eviee:or Equivalent 5lgns 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 ifdeslred or as required by the inspector of Wires. Estimated Value of Electrical Work % /5 OO (When required by municipal policy.) Work to Start ,- tions to be requested in accordance with MEC Rule 10,and INSURANCE COVERAGE: Unless waived by the owner,no upon complytion 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 penaider ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: o e o Signature LIC.NO.: Li D©l 2. llfopplicabk,enter"exempt"in the license"' �line.) Address: �3 . / Ic7t'��t �,yt f} 1]�. Bus.Tel.No.: •Per M.G.L.C. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No.: iT-aOb-7}9s- OWNER'S IN URANCE WAIVER: 1 am aware that the Licensee doer not have the liability i -:,,ce coverage normally required aw. my si J below, by waive this requirement. I am the(check one ►Owner gent p •saner 111 ownersa.ent Signs a Telephone No.7742.4(?2 PERMIT FEE:S n X