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HomeMy WebLinkAboutBLDE-22-000108 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-000108 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:7/8/2021 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 describ d below 14Ft- (35_6 Location(Street&Number) 41 HEATHER LN i.j� Fff Owner or Tenant HilidaElieMeTlielfialitiliE.E Telephone No. Owner's Address HI 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 ❑ 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: Septic pump&alarm. 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 i 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 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 1 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 Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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: Robert C Silverberg Licensee: Robert C Silverberg Signature LIC.NO.: 12216 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: PO BOX 445,WEST WAREHAM MA 025760445 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 b- 7/1 (24.. RECEIVED Consmonwsa/Ih o/maeeackasstb Official Use Only J U ,.. •• 4, cc77�� cc77� Permit No. 22�a 1 D 8 2sparimeni a�.fir e Stroked B U I L D I N r.► � Ety� Occupancy and Fee Checked By k_j B• RD 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: 7—�I City or Town of: i��-ol�r Tit 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) '1 7 LW Owner or Tenant 15 tL(_ ISr-ri-e,e¢4",-T- Telephone No. Owner's Address ( Is this permit in conjunction with a building _ Yes [XI No ❑ (Check Appropriate Box) telid_ ( Purpose of Building S/b%)&-(,f l (Ly �WcGCr' -' Utility Authorization No. Existing Service 1,0-0 Amps 120 /;cfPVolts Overhead© Undgrd 0 No.of Meters / v New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters w Number of Feeders and Ampadty I Location and Nature of Proposed Electrical Work: two Scp 714- Pu.stP f 44{0'1 Completion of the followinktabk m be waived by the I for of Wires. -.0 No.of Total i„b No.of Recessed Luminaires No.of Ceti.-Soup.(Paddle)Fans Transformers KVA V °" No.of Luminaire Outlets No.of Hot Tubs Generators KVA r.':. No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting Enid. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.Ifni Detection tln levi�cea r: No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons .__I'_ "No.of Self-Contained Totals: — . �... Detection/Ale�Deviaa No.of Dishwashers Space/Area Heating KW Local 0 C :* onnection 0 Other No.of Dryers Heating Appliances KWSecuritNo. f Devicesor Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Tel N munications of Devices or Equ�nt 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: 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 Pp BOND 0 OTHER 0 (Specify:) I certify,under thens and penalties of perj ,that the information on this application is true and complete. FIRM NAME: 341/6/4 0.ltr 64_6-C It CoLIC.NO.: 4(Z2/6 Licensee: 20.6 O �'ti,V(bQ(&- Signature s)✓(,r,-f4 ,1��' LIC.NO.:6-A?(If applicable,enter"exempt"in the license number line.) / Bus.Tel.No.• Z r Address: 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 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 PERMIT FEE:$ Signature Telephone No.