Loading...
HomeMy WebLinkAboutBLDE-21-006703 Commonwealth of Official Use Only E0Massachusetts Permit No. BLDE-21-006703 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:5/19/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 21 TRUMAN LN Owner or Tenant DONAIS JEFFREY A Telephone No. Owner's Address DONAIS MARGARET E,56 RIDGE RD,SOUTH HADLEY, MA 01075 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 Agrnboved. ❑ In- grnd. o No.of Emergency Lighti 0 l� Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARM'! �•�' • Z No.of Switches No.of Gas Burners 1 No.of Detection ate+• Q Initiating Devices O No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices O Tons No.of Waste Disposers Heat Pump Number Tons KW No,of Self-Contained O Totals: Detection/Alerting Devices4.1, V , No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Connection �� No.of Dryers Heating Appliances KW Security Systems:* O No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens 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: KUNG-PO TANG Licensee: Kung-Po Tang Signature LIC.NO.: 21928 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:518 COTUIT RD, MASHPEE MA 026492351 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 J)f 71cf r Commontveaig o/M7amachuoeth Official Use Only '' * �, - l 2)epartment o`. ire Serviced Permit No. —w7/03 1 I = " Occupancy and Fee Checked ';, _F,, 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 INF RMATION) Date: �—( - 2 City or Town of: l<-',Ly `ii„4.0._ 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) Z4 7Vtl/yrt©�,,i t_.0-.-t,x_ Owner or Tenant pi)n c. S Telephone No.T H 3 <-3/- 12f3 Owner's Address Is this permit in conjunction wi h a building permit? Yes ❑ No i] (Check Appropriate Box) Purpose of Building j iQ- i C"7 > c-, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd LI No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /101--( of/ Gi-17/ Completion of the followin&table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans TrranoKVA Tf KVA sformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting grad. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones I No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Ranges No.of Air Cond. f Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1W No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Connection 0 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 ui No.of Devices or Eqquivaa lent 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: S "a"'L/ 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 Er 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: LIC.NO.: 2../ 2 f-1} Lfrenstee: L ----- r L: Slgnatur• -- LIC.NO.: <2 2 -P (If applicable, enter + /in t e lice a mb line.) Bus.Tel.No.: ?V/y561--7 S 7:3 ;; Address: !r � Pi,i 4 hit--6€ !{-�� v Z �Y Alt.� AI .T 1 e.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 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/Agent Signature Telephone No. - PERMIT FEE: $