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HomeMy WebLinkAboutBLDE-22-004804 . or Commonwealth of Official Use Only 'L` Massachusetts Permit No. BLDE-22-004804 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:3/1/2022 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. Location(Street&Number) 3 BUCHANAN RD Owner or Tenant LYMAN JEAN A TRS Telephone No. Owner's Address LYMAN STEPHEN E TRS, 3 BUCHANAN RD,WEST YARMOUTH, MA 02673 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: Wire family room. 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 No.of Detection and Initiating Devices otal No.of Ranges No.of Air Cond. TTot No.of Alerting Devices Ti No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained t Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ ConnectionMunicipal 0 Other: n No.of Dryers Heating Appliances KW Security Systems:* sk No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Enuivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eaur alent 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: JOSHUA B DEJOIE Licensee: Joshua B Dejoie Signature LIC.NO.: 53490 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 LEXINGTON LN,YARMOUTH PORT MA 026752437 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: $75.00 P.-.0-0 C•24/ ?i✓t(7 £ 7\ &N 7 IRECE ` VIED I.--- Permit ` ,/ Commonavat 4 i i/assaC ito USe Only FEB r. c7� -. I'.-2-. -'—f 900 is +" 2Jepartuunt `�' S' Permit No. f o u+r civic?? _i i DI N.9 ut ;: !`` T BOARD BUIL ,, �! OF FIRE PREVENTION REGULATIONSp8°�and Fee Checked ©Y _-- = [Rev. 1/07] (leave blank) i APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed in acaotrlance with the Massachusetts Electrical Code 527 CMR 12.00 (MEC), (PLE„ASEPRINT ININK OR TYPE ALL INFORMATION) Date: a-a -a . City or Town of: YARMOUTH To the Inspector of Wires: j �y this application the undersigned gives notice of his or intention to perform the electrical work described below. i l ocat on(Street&Number) B A�6, k t)o,�, ,. Owner or Tenant ?c.iN L c.On (!1 Owner's Address 3 t3 Telephone No. 506.x]'71�"�(5 Is this permit in conjunction with a building permit? Yes hi No 0 f arpose of Badding �J e t`�n (Check Appropriate Box) Volts Overhead Utility Authorization No. S Existing Service Amps / Voi � New Service ❑ Uadgrd 0 Na of Meters ,1Amps / Volts Overhead 0 d Und r K1 '' Number of Feeders and Ampacity g❑ No.of Meters Location and Nature of Proposed Electrical Work: (,� c e e W ti�i z roc in Co ,,!etion. the ollowi ; table m- be waived b the In No.of Recessed Luminaires omror o Wires. M,i Na of CdL-Soap,(Paddle)Fans o.o Na of Luminaire Outlet Transformers KVA Na of Hot Tubs Generators KVA ` No.of Lunalnaires Swlmmiag Pool ' ' e n- ❑ 'O.o 'mergency ' ;ng " l�io.of Receptacle Outlets � �d' ❑ " � � Bette Units ..., No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners. 'a o , 1 i.r Inidatin Deaviices Na of Air Coad. Tons No.of Alerting Devices o.of Waste Dbposers • Totals: ._:.uw�Yr ons.... ' " 'o.o v3 on, a , i�a of Dishwashers .. .. Detection/Alert's Devices Space/Area Heating KW Local nn�� Na of Dryers 0 Conueetion ❑ Other '.o.o + Heating Appliances KW yt+tema: KW 'o.o `o.o Na of Devices or ' titivated Data Wiring: No.Hydro Heaterssrrge Bathtubs S ,s Ballasts No oDevices or ' ,uh'alent OTHER: No.of Motors Total HP e Na omen ; ,� +1 . g: Devices or ' .eivaleat QD DAttach additional detail tf desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -aa Inspections to be requested in accordance with MEC Rule 10,and upon completion. [N$URANCE COVERAGE: Unless waived by the owner no the licensee provides proof of liability „' permit for the performance of electrical work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the insurance including completed operation”coverage or its substantial equivalent. The CHECK ONE: INSURANCE ( . BOND ❑ OTHERpermit issuing oi}icc. I certify,tinder the , -fns and Penahies o� 0 (Specify:) FIRM NAME: ynry•that the information on this application is true and complete S�.v� e,To-e b`eG�c1 t.*c" Licensee: o�1‘oc L a e -�� LIC.NO.: (If Address:applicable.enter"exempt"in the; ��e number line.) Suture/ - LIC.NO.: (10-6 r ... w(‘D, , Zl/'� *Per M.G.L.c. 147,s.57-61, _ Bus.TeL No.. 3 OWNER'S INSURANCE WAIVER:`I amainrequires w�tDepartment ee does not have the liability ma�No.: Safetyf Public "S"License: ML Lic.NO. required by law. By my signature below,I hereby waive this i Owner/Agent requirement. I am the(check one o ce coverage nom— a:ent. Signatureweer ne owner s a:ent. Telephone No. PERMIT FEE:$ i