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HomeMy WebLinkAboutBLDE-22-002435 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002435 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:10/28/2021 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) 60 BROOKHILL LN Owner or Tenant BOGDAN DIANE Telephone No. Owner's Address 26 CLEARVIEW AVE, EAST HAVEN,CT 06512 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, 5 CO Detectors, &3 Smoke Detectors. 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. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Toon l No.of Alerting Devices TNo.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 8 Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: 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 Siens 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: THOMAS J MADDEN Licensee: Thomas J Madden Signature LIC.NO.: 14065 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:39 MARINERS LN,PO BOX 291,YARMOUTHPORT MA 026750291 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 / 1 I RECEIVED ' ;, OCT 2 8 2021 00`` r�j o •nava o�r//a6aat/�iudat'fa Official Use Only Permit No. 7i 35 'X Lr+�`rr G U t F'A R T M E NTA par�nf o/e3"L sirvies6 11 ii r • ;1 i;'i Occupancy and Fee Checked 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 CodC ). .00 M 527 MR 1; (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: )0QG c7 ( City or Town of: YARMOUTH To the Insp ctor o fres: By this application the undersigned gives no ice of his o her inten i.n to p o the eleftrical work described el w. Location(Street&Number) „Q ,,`irk wr/GL .//0 (J Owner or Tenant D/4 11 i©p _4,A1 Telephone No. 101p3--9et oOf9' Owner's Address �J Is thispermit in con uncti with a building 1 permit? Yes 0 No �K (Check Appropriate Box) Purpose of Building Xe 5 / Utility Authorization No. } Existing Service /60 Amps /cO/tik/oits Overhead E.----iJndgrd❑ No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampadty Locatioy and Nature of Proposed Electrical Work: U"ip,L, p 0 Nat.& ai I , , , `..('/02 � .erPt<1li/47 4 v Jr-cad sp4,0/�0) f 3 /4/„o - i rola A �S U Completion of the followinktable m be waived by the Inspector of Wires. ii.,: No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of VA „, K Transformers KVA i•-,,, No.of Luminaire Outlets No.of Hot Tubs Generators KVA 'k No.of Luminaires Swimming Pool Above o In- ❑ No.of Emergency Lighting grad. and. 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 p Initiating Devices Q l•' No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 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 1--7 Other Connection No.of Dryers Heating Appliances KW Security SyNo. stems:* or Equivalent No.of Water No.of No.of Heaters KW 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: r Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of ectri 1 Work. �L] o v( When required by municipal policy.) Work to Start: d Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE 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 covers is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:) I certify,under the,,, ns a d enalties of.rjury,that the lnformatIon on this application is true and complete. FIRM NAME: �r.�. �� `li' - ����//��A LIC.NO.: Ji-k3,6S, Licensee: ��111laj� — Signature ►i �Wgri LIC.NO.: (!f applicable, r"ex pt"in the Ii ense number line Bus.Tel.No. �Z 27 Address: r49 e0( ek / of �� / �' 7s Alt.Tel.No.: __ Jr *Per M.G.L.c. 147,s.57-61,security work requ' 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/Agent Signature Telephone No. PERMIT FEE:$