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HomeMy WebLinkAboutBLDE-22-005336 Commonwealth of Official Use Only i_.. Massachusetts Permit No. BLDE-22-005336 1 ,1 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:3/24/2022 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 described below. Location(Street&Number) 22 TERN RD Owner or Tenant Glenroy Burke Owner's Address 22 TERN RD, SOUTH YARMOUTH, MA 02664-2051 Telephone No. Is this permit in conjunction with a building permit? Yes 0 No 0 (Ch. t 1! �� Purpose of Building Utility Authorization NI d Existing Service 100 Amps Volts Overhead ❑ �` Undgrd 0 v or' New Service 200 Amps Volts Overhead 0 Undgrd ❑ Number of Feeders and Ampacity g No.of Meters Location and Nature of Proposed Electrical Work: Upgrade service.(POLE 441/3) 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 grnd e ❑ grnd. ❑ No.of Emergency Lighting 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 Initiative Devices No.of Air Cond. Total No.of Alerting Devices Ton No.of Waste Disposers Heat Pump I Number I Tons 1 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 Heating Appliances KW Security Systems:* No.of Water No.of No. No.of Devices or Equivalent Heaters ' 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 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 ❑ BOND 0 OTHER ❑ I certify,under the pains and penalties o (Specify:) fperjury,that the information on this application is true and complete. FIRM NAME: DAVID R NICOLL Licensee: David R Nicoll (If applicable,enter"exempt"in the license number line.) Signature LIC.NO.: 37557 Address: 144 DRIFTWOOD LN, S YARMOUTH MA 026641038 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 my signature below,I hereby waive this requirement.I am the(check one ) 0 owner ❑ owner's agent. Signature Telephone No. � � PERMIT FEE:$50.00 sks' 717,--av, _ =- REDEIV D /� ,yi n att� ol�!/�aJachu:cfit Official Use Only t Ey p 7 JJ� �t '1 MAR 2 J 202 8 r ?}' Permit No. i l .nf n :lire a:rvice5 `�` + : ��G l= "REVENTION REGULATIONS Occupancy and Fee Checked Z.r,.,. • By U I L EP1�I�TM E N T [Rev. 1lQ7) (leave blank) A ` ' A * ` . - 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 TYRE/ALL INFORMATION) Date: (A k12 , - 1 (CSC City or Town of': Mims!)t To the Inspector of Wires: By this application the undersigned ives notice of his or her int ntion to perform the electrical work described below. Location(Street&Number) �� Owner or Tenant c-6\ .,r y 44 tio9esk CTelephone No. / .)C6- Owner's Address [/1// 3 Is this permit in conjunction with a building permit? Yes 0 No Qf (Check Appropriate Box) �' Purpose of Building Utility Authorization No. f .t S Existing Service j660 Amps tat) /ditAiolts Overhead e Undgrd ❑ No.of Meters New Service C9 w Amps 'aZ /altOVolts Overhead it Undgrd❑ No.of Meters l Number of Feeders and Ampacity 3 Location and Nature of Proposed Electrical Work: D\ri; AJ S �u i� Calk-/ ,÷ 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, grad. Battery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS jNo. of Zones No. of Switches No.of Gas Burners No.of Detection and No.of Ran es Total Initiating Devices g No.of Air Cond. To No.of Alerting Devices No.of Waste Disposers • ' Heat Pump t Ngrnber_ _T _4 s. KW No.of Self-Contained Totals:( Ar Detection/AIerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No.of Devices or Equivalent Heaters KW No.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 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: Inspections 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 Iicensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such cc rage is in force,and has exhi. CHECK ONE: INSURANCE p _d proof of same .ermit issuing office. 1 certify, under the •'ins and penalties o BOND ❑ OTHER ■ (Sp: ify:) fperjury,that the in forma on on th's ap,J'-.tit is true and FIRM NAME: 1 ,.4►. N rt a l.L. , mpleie. Licensee: �" . . �� LIC.NO.:_ 7 S 5 7 E Signatu -11 as r LIC.NO.: (If applicable, enter"exempt"in the license number line.) V Address: ��l{ I Fria 4? %irk Bus.Tel.No.: '0� 3ri -0131 *Per M.G.L. c. 147,s 57-61,security work requires Department of Public Safety "S"License: Lic.No. OWNER'S INSURANCE W Alt. Tel.No.: u 6__31Q. 3c U AIVER:I am aware that the Licensee does not have the liability insurance coverage normall required by law. By my signature below,I hereby waive this requirement. I am the(check one) Owner/Agent r y Signature c-4, V\J� rj A.A. CAS ❑owner ❑owner's agent. Telenhnne No. 9 � v� PERMIT FEE: $