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HomeMy WebLinkAboutBLDE-22-000821 ,. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-000821 -,� ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:8/13/2021 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) 25 LEGEND DR Owner or Tenant Christina Conklin Telephone No. Owner's Address 25 LEGEND DR, SOUTH YARMOUTH, MA 02664 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: Replacement HVAC. 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- 0 No.of Em 'gh ' o grnd. grnd. Battery Un No.of Receptacle Outlets No.of Oil Burners FIRE ALARM 1 1*a i ne • No.of Switches No.of Gas Burners 1 No.of Detection and 8- v Initiating Devices 6 Ranges No.of Air Cond. 1 No.of Total No.of AlertingDevic Tons � <;; No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained /� Totals: Detection/Alerting Devices !J No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 er: 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 Signs No.of Devices or Equivalent 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. FIRM NAME: Licensee: Matthew Gordon Signature LIC.NO.: 55830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:22 Station Avenue,South Yarmouth Ma 02664 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: $50.00 RECEIVED -- /� aa�� y�j� AUG12 ..!...7., ,� Comnwnwea&/ o////addachiudafld Official Use Only 1ti' ,t Permit No. X22 — O Z4 t�', 2s art,n.ni o/.7u s&i.vlcad BUILDING DEP`-f!�I1;� P By: "'' '�" BOARD OF FIRE PREVENTION REGULATIONS [ e / 7Occupancy and Fee Checkedn ) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code EC),5 7 CMR 12 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ' // Z /2 I City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his o her• ntion to perform the electrical work described below. Location(Street&Number) lee"e h r Owner or Tenant Ch r;S--;n(,( i k(;r Telephone No.C /13 3- 3/30 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Propos Electrical W rk: H -j--,er- r j/(/i r-c_.c,� A c � t'ih ) r rcw,reA eitn br4-1 ec eic‘>1 &:4 NA V) Completion oflifefollowinvable may be waived by the Inspector of Wires. Ch No.of Recessed Luminaires No.of Ceil._Sas No.of Total •ofp.(Paddle)Fans Transformers KVA CA No.of Luminaire Outlets No.of Hot Tubs Generators KVA t No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. grnd. Battery Units `` No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones , hNo.of Switches No.of Gas Burners 'No.of Detection and t•! No.of RangesTotal Initiating Devices No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained Totals:l......_...._... _....� 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ 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: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Valui.if Eloirisal Work: (.) (When required by municipal policy.) Work to Start: 2 I 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: INSURANCES BOND 0 OTHER 0 (Specify:) I certify,under the pains a , .enables ofpe ry,t 't the Information on this application is true and complete FIRM NAME: V , I '%.\J p ,p LIC.NO.: 55-,Q3 OF Licensee: v 1111111I , 0 t• . Signature - � LIC.NO.: (If applicable,enter"exempt"in the lir a numb r line.) Address: -'O �'�$'S/ "Ve ,,v � Bus.Tel.No.: (,),.3—'?"06--c7-7.O *Per M.G.L.c. 147,s.57-61,securitork requires Department d Public Safety"S"License: Alt.LicTe1�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 ❑owner's agent. Owner/Agent 1 Signature Telephone No. I PERMIT FEE:$