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HomeMy WebLinkAboutBLDE-21-007592 or Commonwealth of Official Use Only ift.;,^,t • Massachusetts Permit No. BLDE-21-007592 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:6/29/2021 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 electncal work described below. Location(Street&Number) 66 RANDOLPH RD Owner or Tenant Robert Phillips Telephone No. Owner's Address 66 RANDOLPH ROAD,YARMOUTH PORT, MA 02675 4,, Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec C. ' . ' ) Purpose of Building Utility Authorization No. + �� Existing Service Amps Volts Overhead 0 Undgrd 0 .0.#9""i e y) f? ?e..._. New Service Amps Volts Overhead 0 Undgrd ❑ rs Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wire HVAC. 0 0 a Completion of the following table may be waive , `u .•ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 'tal Transformers A 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 Initiating Devices No.of Ranges No.of Air Cond. 1 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 Signs 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: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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 Commonwealth of///a66acLuostt6 Official Use Only '_ Al '�/ tc�/� cc''�� n Permit No. � 7q� ' . JJsparfansnt oi.}irs Sri/kips 1;-, : Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELE TRIC ' L WORK All work to be performed in accordance with the Massachusetts Electrical Code Es , 7M' 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: © ?" • City or Town of: YARMOUTH To the Inspec sr of W' es: By this application the undersign"a I. es .I.15,ce of is o h tenti'4/to • a rm the elect cal work a escribed below. Location(Street&Nuler , r i ,1/ 1 / a ©/ #- Owner or Tenant D C/' - � '/,f Telephone No. Owner's Address / e / Is this permit in conjunction with a building permit? Yes#1 No/K (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty I Location and Nature f Proposed Electra« Work: '_ a a. I " e d t' 6'74e4.cPt`—u 04 C pletion of the followinKtable may be waived by the Invector of Wires. Total No.of Recessed Luminaires No.of Ceil.-Susp. addle)Fans Tof Transformers KVA 'Z No.of Luminaire Outlets No.of Hot Tubs Generators KVA n <k No.of Luminaires Swimmin Pool Above In- No.of Emergency Lighting g grad. grad LI Battery Units �` No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Y No.of Switches No.of Gas Burners No.of Detection and Initiating Devices III No.of Ranges No.of Air Cond. Tons No.of AlertingDevices 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 0 Municipalnnection 0 other Co 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 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: 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 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is ue and complete. FIRM NAME: _if I ► / LIC.NO.: Licensee: _I L,d,�,(/ Signatur Of /' i� / �� LIC.NO.: (If applicable yy��►��+ve4 e ober ire.) ��Q Bas.Tel.NO.' Address: //(/ • - Alt.Tel.No.: r?3�*Per M.G.L.c. 147,s.57curity work requires Dep ent o/ etylblic`Sa "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that th 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:$ I-10 RECEIVED JUN 2 9 2021 BUILDING DEPARTMENT By: