No preview available
HomeMy WebLinkAboutBLDE-22-003822 T Commonwealth of Official Use Only 4: 111iii01,‘ ! Massachusetts Permit No. BLDE-22-003822 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:1/10/2022 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 des nibed below. _ Location(Street&Number) 80 GREAT WESTERN RD 13 1 S' I(q) Owner or Tenant HAGOPIAN MOLLY E l . Owner's Address 80 GREAT WESTERN RD, SOUTH YARMOUTH, MA 02664 Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 New Service gNo.of Meters Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New bathroom. • 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- CINo.of Emergency Lighting grnd. 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 Initiating Devices No.of Ranges No.of Air Cond. Total Ton No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: l Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No,of Ballasts Data Wiring: Signs ,No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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 ❑ 8 , o,_.,(ft -' I certify,under the pains and penalties o (Specify:) p (perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Igor V bondarenko Signature Tel. NO.: 22644 (If applicable,enter"exempt"in the license number line.) Address:9 Pond View Drive, Harwich MA 02645 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S" 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 my signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. s I PERMIT FEE:$75.00 I ice' {°'r t (i n(Z 6 (,, 30 0,4) ,,,, &Elmo,"td Nbi Ltf9tf� ,r, . , r riew/2-v 9/ ' ;.ef.c,e its f'o cif 1,, -e tit/c e COe..r -7'7 ///c'/?z i k- 0©oft X , //i'd C:Ce- - / Ec1III _ D . .- iii, sakiel Massacksodis °fficial use only } 4 ' JAN 0 7 2022 i - 4 .g Permit No. Z - 22 'II! , I L o I Pe .- •r REVENTIQN REGULATIONS ev. 1/0°cY and Fee Checked AY [t€er.I/tr>]1/444, (leave blank) A. • ' ® PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ck (PLE.4SEPRINT IN INK OIt TYPE (MEC),52?CMR t2.00 aRMATION Date: / 6/2 2.. City or Town of: Jjo�d � ©Cv By thisapplication the To the Inspector of Wires: undersigned gives notice of his or her intention to perfoan the electrical work described below. O Location(Street&Number) .7C0 6.rejg I A/E.f,1er 1 Owner or Tenant /�.p /`?rl/Zi/1r4(/ Owner's Address / Telephone No. s©13 "'3S'2'b Sa!°� N Is this permit in conjunction with a building permit? Yes !Pr' No 0 (Check Appropriate Box) kt Purpose of Building '<,Pr f2e4,7'1 q — Utility Authorization No. Ezisttng Service 240 Amps /2v / z-Y4'olts Overhead[ Und8rd❑ No.of Meters / z New Service Amps / Volts Overhead 0 Undgrd Number of Feeders and Ampnthy Na.of Meters Location and Nature of Proposed Electrical Work: Completion of the follow' table may be waived by the! tor of Wires. vt ill Na of Recessed Laminaires/ No.ofCdL-Snsp.(Paddle)Fans No.of KVA No.ofLinnineire°Wets Generators Transformers No.of Hot Tubs Geerator KVA No.of Laimtnt tr es Swimming Poe, Above In- No.of Emergency Lighting Ind. and, Battery Units `t No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones No.of Switches No.of Cas Burners o.of Detection and i No.of RangesInitiating Devices No.of Air Cont. TOE No.of Alerting Devices Tons No.of Waste]C Heat Pi nrp Number Tons KW Total: ~~ .— o.of Self-Contained No.of Dishwashers .. .. Detection/Ale , , Devices Space/Area Heating KW Local Li Muni a+, Li Other rlo.of Dryers Neat( Cannectlon Heating APPlauces KW Security :* No.of Water KW No.of No.of No. or Equivalent pats Wiring. Heaters No.Hydroage Bathtubs No. Ballasts Nu ofDevices. ar uivadent No.of Motors Total HP Timm ors ' + +,. , OTHER. No.of Devices or Fq t n'Z, O _ Attach additional detail(desired or as required by the Inspector of Wires. Estimated Value of Electrical Work:' �Work to Start: / � Z� (Whenrequiredby municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the the licensee provides proof of liability insurance includingperformance" verag of its substantial work may issue unless undersigned certifies that such coverage is in force,and has exhibited proofofs a to theee or issuing nequivalent. The CHECK ONE: INSURANCE BOND of same to permit issuing office. 1 eerllJy,wider the pains 0 OTHER 0 {Specify:} FIRM NAME: ?i an penm�,ofpe jury,that the ormadion on this application is true and complete. 3 ti 91z-4 ,Co :tu e_ /c7.c Cr;4 GCC LIC.NO.: /I.ZZ6+ y Licensee: (j��r�Q Signature --- -_.....,. (1faPPlicabie,gofer tin the license member line.) LIC.NO.: t'4'Z ` Addrem: yni> Ur4v Drc�� - /-1.9r 'Sus.Tel No.:tea? 3tiv �8 - *Per M.G.L.c 147,s 57-61,security work C � ®Zfi 4� requires Derailment of Public Alt.Teo No.: -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee Safety e t License: Lic.No. required by law. By my signature below Idoes not hove the liability insurance coverage norrnall Owner/Agent hereby waive this ( I am the eck one II owner y Signature owner's a_ettt. Telephone No. PERMIT FEE:$