The URL can be used to link to this page

Home My WebLink AboutBLDE-22-004095 Commonwealth of Official Use Only f "' Massachusetts Permit No. Bum-22-01340952 - • 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:1/25/2022 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. O Location(Street&Number) 4 BEVERLY RD ,0 , ( 1�� ciaS Owner or Tenant REJNIAK MARK A Telephone No. Owner's Address REJNIAK BARBARA E, 16 GILBERT RD, SOUTHAMPTON, MA 01073 Is this permit in conjunction with a building permit? Yes 0 No 0 (� Purpose of Building Utility Authorization ' Existing Service 100 Amps Volts Overhead 0 Undgrd ■` 'o.o `e ers New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service 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 ElIn- 1:1No.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. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertinu Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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. d n_z_ 0-9 2 FIRM NAME: SHERWOOD E LEWIS D J Licensee: Sherwood E Lewis Signature LIC.NO.: 11503 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: PO BOX 283,YARMOUTH PORT MA 026750283 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:$200.00 &-(23. 11(5(927/1- ------ ....__ L a,1/1 . rRECEJVED ..: 4 ,"wealth _/Mamaducutid Official Use Only 24 w+ '1 AN2022 ��1 Permit No. '.. - l i L;i r1!‘.,I. NT Occupancy and Fee Checked y- tIO`A`f D_OF IR= PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Jan, 2L/ 2.o 2-2— City 2City or Town of: ��m 0 U.t' To the Inspector of Woes: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) y c3 e-Ve. RR004.A, v e S 1 yGtt"61i O tAY n (fl A 0 247'3 Owner or Tenant ('A IC Rt jr B�'K Telephone No. Owner's Address9 Bever,/ Q a d WtS F YACpn0 N I S /Yt IA D Z,73 V Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) v Purpose of Building Utility Authorization No. 7(, 5 3 3'1 3 • Existing Service I 0 0- Amps 11 0 / (10 Volts Overhead® Undgrd 0 No.of Meters New Service I 0 0 Amps 11.0 / 110 Volts Overhead® Undgrd ❑ No.of Meters Number of Feeders and Ampacity 5'n I,e P ern$e Location and Nature of Proposed Electrical)Work: lAee'rA jnq I 06 anh p St N1 Lr G ie . 1 o R. --C Cc-ilk-cc 19FnGt Olt , / 1 Completion of thefollowingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp Tf Total�addle)Fans Transformers KVA `-- No.of Luminaire Outlets No.of Hot Tubs Generators KVA "� No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of>N mergency Lighting ,�l g grnd. grnd. Battery Units 0) No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Z No.of Switches No.of Gas Burners No.of InitiatingDetengon and InDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices V Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices al IZ No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other `j No.of Dryers Heating Appliances KW Security Systems:* ''YNo.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent E No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications quival No.of Devices or Equivalent W 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: 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 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 ill BOND 0 OTHER 0 (Specify:) I certify,under the tains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: jn2f'WQ 0 A Levy; S LIC.NO.: i Licensee: Signature ,, LIC.NO.: l'SO (If applicab4,enter"exempt"in the license number line.) Bus.Tel.No.- r•22' r3? Address: I' b, Ault (i q i O eflni SOpr. A. 01(03/ Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security worklrequir� �N s Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/AgentPERMIT FEE: $ SignatureTelephone No. c3 —74k0 q5'3 t. tel 08301 �-