HomeMy WebLinkAboutBLDE-21-004776 °'
0 - Official Use Only
� �, Commonwealth of
Permit No. BLDE-21-004776
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:2/23/2021
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) 95 OLD MAIN ST
Owner or Tenant Peter Dunbar Telephone No.
Owner's Address 95 OLD MAIN ST, SOUTH YARMOUTH, MA 02664-6009
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 studio.
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- o No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 2 No.of Gas Burners No.of Detection and
Initiatine 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/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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
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BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank)
APPLICA11014 FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be paformed in accosdance whir the Massacheenta Electrical Code - :, 527 CMR 12.00
... (PLEASE PRINT IN INK OR TYPE ALL INFORMAT1014) Date: 21 a 1 at.Pa-/
.., City or Town of: S a u T/4 )(A&07 ot.9 114 To the inspector of Wires:
..; By this application the undersigned gives notice of his or her Wendell to perform the electrical work described below.
C Lecatiee(Street&Number) 9s" 01-6010 11,-3 'ST -I ttuoutti -IAA,* .
chnier er Talent Pg-reA., Telephone No49'12-474?•0491—
Osvaer's Address 9 i- 0c 0 th 4 4A-> Sl- _S_lit&frti o ark, Met
\,.3 Is this pens*in conjunction with a building permit? Yes El No 0 (Cheek Appropriate Box)
Purpose of Bulldog 04.47 Srei-4,4 UMW Andierizefien Ns.
-k 1
so I Waft Service /Co Amps /20 / 4Q2Veils Overhead(SO Undgrd 0 Ne.of Meters _l____
-1'3 I
New Service Amps 1 Volts Overhead 0 thadkgrti 0 Na of Meters _
,k1 Number ofFenders and Aripacity
(-4.,i Location and Nature of Ptuipesed Electrical Work: S7I.,p4itt
'in Campledon of the foilowinctabk attl,be waived by the Ingsector of Wires.
Ns.et Total
No.of Recessed Lumimaires Ne.of C .-Sasp.(Paddle)Fans Tniusfensers EVA
Q., Ne.of Luminaire Outlets Ns.of Het Tubs Generaten KVA
Above r- W1- in NC et naneripsey urines
-4:- NO.of Lammhiskes SwilMadill Peel and. L.-4 and. I—,Battery Units
l'zIt No.of Receptacle Outlets 5 No..1011 Burners FIRE ALARMS 'No.of Zones
We.of Detection*ad
Ne.if Switdaes 2i No.of Gas Burners i_ Initiative Devices
*.,
Total
/141o.of Alerting Devices
No.easing= - No.of Air Cond. Teas
Ne.of Waste
Rest Pump Number-Tens I KW teecideSeirataleed
Disposers Utak:_
No.of Dishwashen fipaedArea Heating KW Lead 0 0 Other
Ne.of Dryers Heating Appliances KW Seanity Systems:4
Ng.id Devices es Findvalent
No.et Water Ns:of No.al 'Data Wirier
neaten K1V
Signs Mesta No.ef Devices or M
No.Hyde -- -Bedaubs Ns.if Motors Total HP Telecemaaturicadsns
Ns.of Duda*er
OTHER:
ti , Attach adiftional detail#iiesirest Or Or required by the&yeah,of Wires.
Estirnated Value of Electrical Work: / •) .0 0 (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule IQ,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work any issue unless
the licensee provides motif of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited'woof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specifr)
I certry,ander the pokes and penakies of per ,that the infonnation on this application is*we and complete.
FIRM NAME: LIC.NO.:
licensee: Signature LIC.NO.:
frapplicable,enter"exempt"in the license member Thiel Has.Tel.N.
Addye=
Alt Tel.NC:
Per M.G.L c. 147,s.57-61,secwity work mquires Departmem of Public Safety"S"License: tic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. 9t my signatr beim,I hereby waive this requirement. I am the(check one) owner Downer's agent.
Owner/Agent 0/./ ...., if }404.kii
Signature g leg•(Lig‹ I
Telephone . it - 1 PERMIT FEE:$ I