Loading...
HomeMy WebLinkAboutBLDE-21-006541 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-006541 B ARD 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:5/12/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertomm the electncal work described below. Location(Street&Number) 109 OLD MAIN ST Owner or Tenant MITCHELL THOMAS Telephone No. Owner's Address MITCHELL CHRISTINE A, 22 BURNTMEADOW RD, GROTON, MA 01450-1539 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 boiler. /� f/Q Completion of the following tab X44, ,' wai • n gitor f Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of II Transformers • No.of Luminaire Outlets No.of Hot Tubs Generators No.of Luminaires Swimming Pool Above ❑ In- o No.of Emergency Lighting/ grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zo </S� No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 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 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: Michael D Hollister Licensee: Michael D Hollister Signature LIC.NO.: 10071 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:85 N DENNIS RD,S YARMOUTH MA 026641017 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 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 kfl A St CV( e iciy4 '/7/74 ee.(Z=ospv+ < ,v) J0 ttyy� 14 Cowrwronsrea[ti of��laeesckwus Official Use Only 4 _" Permit No. i 2A.-1p 5 j Th�4 �.,w; 1-- ! Occupancy and Fee Checked . J BOARD OF FIRE 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: c/11/2( L-' City or Town of: ,ALL M p ark) To the Inspector of fres: t By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 1 Location(Street&Number) /09 6/ 7 i'Y 141 N S't L T S. \( f"Gu'? Owner or Tenant 7"D OA tv t77fl t 1 Telephone No. 77q 2 I Z 2 t Owner's Address ' i W Is this permit in conjunction with a building permit? Yes 0 No [} (Check Appropriate Box) J¢ Purpose of Building E' 5 t Cts r�rtCtr Utility Authorization No. 1 Existing Service )b1' Amps 17,/,? o Volts Overhead❑ Uudgrd 0 No.of Meters _____L__ w New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters al( Number of Feeders and Ampadty J( - /1(Cyy ge,I (... . 47 al Location and Nature of Proposed Electrical Work: o` `n Completion ofthe fou table be waived by the! of Wires. vi Total awlec�► LL No.of Recessed Luminaires No.of CeIL-Susp.(Paddle)Fans Tr n KVA Transformers KVA No.of Lmninaire Outlets No.of Hot Tubs Generators KVA n Pool Above In- NO.of Emergency Lighting No.of Luminaires Swimming land. ❑ am& ❑ Battery Units 'v 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 t 0' No.of Ranges No.of Mr Cond. Tonna No.of Alerting Devices No.of Waste Disposers Unit Pump Number Tons KW _ No i Self-Contained evices Na of Dishwashers Space/Area Heating KW Local 0 M� 0 Other No.of Dryers Heating Appy KW Security Systems:* Na of or Equivalent No.of Water , No.of No.of 'Data Heaters Signs Ballasts No.of Devices or � @rr t No.HydromassageBathtubs No.of Motors Total HP Tdeaommun eat onsFliV; slen - No.ofDevices or4 t OTHER: Conach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of 1 • Work: lre) (When required by municipal policy.) Work to Start S' I. Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVE GE: 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 (I BOND 0 OTHER 0 (Specify:) I certify,grader doe pains and penalties ofpelry,that the information on this application is tree and complete. FIRM NAME: fl'i C l C ifiez, S7 jZ cz, - n/ LIC.NO.: /OD?/— 13 Licensee: ((Ca-. Signature LIC.NO.: (Ifapplicable.enter"exempt..in the license number /091e./1"0 lig. Bus.Tel.No.: "7 5-3, 5 Address: 9S /1 f. © C -.1//7/ r- (. '�+/i S K014" ?!P. Alt TeL No.: 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee doer not have the liability insurance co ge normally required by law. By my signt�r+e below,I hereby waive this requirement I am the(check one)0 owner''s agent Owner/Agent Signature Telephone No. 1 PERMIT FEE:$