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Home My WebLink AboutBLDE-21-004517 Commonwealth of Official Use Only i\ Permit No. BLDE-21-004517 fE Massachusetts 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:2/9/2021 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) 25 MARSH SIDE DR Owner or Tenant FATA ROBERT G TRS Telephone No. Owner's Address FATA DONNA TRS, 7 FORTUNE DR, NORWOOD, MA 02062 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: Wiring for basement game 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 0 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 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 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:) Sot 7-Lig- 3 6 Ct 0 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Mark H Chase Licensee: Mark H Chase Signature LIC.NO.: 8669 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:21 DRAKE ST,YARMOUTH PORT MA 026752204 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: $75.00 1:410,,,t.ii tt(1,3(2,1 VI' t. 1"( - i 114 (..ommonweatth o/Mamielumedls Official Use Only, a-eF q .� 2sparimeni ..tins serwic a Permit No. t NI S -V BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1ro7)Occupancy and Fee Checked (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( 527 CMR 12.00 (PLEASE PRINT IN INK OR TYr ALL INFORMATION) Date: V itD-ef a- City or Town of: Yf(.-4"zo tJCfr( To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. U Location(Street&Number) a.S /77/4-25.q S( ie.__ f/l-r .,\J_e... Owner or Tenant B ho -F- boo,-)r)at' EA-TA Telephone No. 39.a 06,—/?„412...._ Owner's Address as- /1F{..<tbe...._ D"-Gur-- `(—P4 7 /I-74 o;7.r J Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building +d — Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters cs'_s Number of Feeders and Ampadty Li Location and Nature of Proposed Electrical Work: (A)14.2_ il.). /34-1,-1- /o op-L1/G -24„r-., ko Completion of the following.table m y be waived by the Inspector of Wires. ut No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total Transformers KVA �l No.of Luminaire Outlets No.of Hot Tubs Generators KVA n k No.of Luminaires swimming Pool Above In- No.of Emergency Lighting nglurid. ❑ grnd. ❑ Battery Units '.2 No.of Receptacle Outlets No.of OH Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices l No.of Ranges No.of Air Cond. Total od No.of Alerting Devices No.of Waste Disposers HeatI otals: (Number Tons_ I _ KW __ Detection/No.of Self-Contained AlerdngDevices No.of dishwashers Space/Area Heating KW Local 0 Municipal Conn 0 Otter No.of Dryers Heating Appliances KW Securitf Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications of Devices or Eq" OTHER: Attach additional detail if desire4 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 aBOND 0 OTHER 0 (Specify:) I certify,under dm pains and penalties of pedury,that the information on this application is true and complete. FIRM NAME: Ge/I E Etjr--e,T1124,6- C®. .Zsv Z_ LIC.NO.: `9i 4 Licensee: /V4( - a/t i Signature 2� 9"64' LIC.NO.: r '9 (If applicableter'ex pt"in the license nurnbe line) Bus.Tel.No_~f Ol/ Address: , 0, x t 1 141 S• •1 3 ,q d'Gu "� r Alt.Tel.No.: 'if.- -C7,6 *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)❑owner 0 owner's agent. Owner/Agent rTelephone No. I PERMIT FEE:$