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HomeMy WebLinkAboutBLDE-22-001502 or t' Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-001502 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:9/16/2021 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) 84 RAYMOND AVE Owner or Tenant Marvette Ellis Telephone No. Owner's Address 84 RAYMOND AVE, SOUTH YARMOUTH, MA 02664 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: Basement renovation Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 19 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 15 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 9 No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Ton l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 2 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 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: $80.00 ( q /23fr( (Z; £ f Lit U) /Z5- 4 ua._ Re-jit45- `t e%t t,0 (-rig Reci`oi* Commonwsatt( l MassacLudis Official Use Only !r 7 Permit Note'-( 7- . . A -x 2epa „.ni o/. Services t; Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1107] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod ,(ME ),527 CMR 12.00_ r (PLEASE PRINT IN INK OR TYP I OMA ON) Date: ( kr 6112012 I City or Town of: yfXf i T i To the Inspector of Wires: By this application the undersi:i . :iv . 'otice of his o h intention to perform the electrical work described below. y Location(Street&Number �♦ L A PERM, // A I 1 Owner or Tenant i l ,�FOR_ Telephone No. (, %- ©H 2 Owner's Address �^ ' F(v(1()( "Y A �. t AC T 4 r ( t�1i MA f Is this permit in conju on with a b permit? Yes J] No 0 (Check Appropriate Box) ` . Purpose of Building Serf t( 1 Utility Authorization No. Existing Service;lC J Amps /240 Volts OverheadIS Undgrd 0 No.of Meters I - New Service 51) Amps /(2't0 Volts Overhead 0 + Undgrd 0 No.of Meters Number of Feeders and Ampacity '-5 reArTS 1/0 A repo u fy . cis Location and Nature of Proposed ElecMcal Work: : .' of ,diLE ;I • ► . AS ,i a F . Completion of the following table maw be waived by the!►4ector of Wires. a., n No.of Total Ll`* No.of Recessed Luminaires f�1 No.of Ceii.-Susp.(Paddle)Fans Transformers KVA Qi No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 1Swimmin Pool Above ❑ In- 0 No.of Emergency Lighting g grad. grad. Battery Units , No.of Receptacle Outlets I 1 J No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches Q No.of Gas Burners No.of Detection and Initiating Devices t'-,' No.of Ran No.of Air Cond. TORI No.of Alerting Devices No. No.of Waste Disposers Beat Pump Number Toes__..__KW rNo.of Self-Contained Totals: Detection/AlertinkDevlces V. No.of Dishwashers Space/Area Heating KW Local 0 Mun a ci n NE] other Cyonnection No.of Dryers Heating Appliances KW SecuriNo. f Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Sys Ballasts No.of Devices or Equivalentg No.Hydromassage Bathtubs No.of Motorstt. Total HF t 'TeleNo Wiring:of Devices or Equivalent OTHER:VIII ala 1]c �/ W-v Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value f Electrical Work: ' c),t (When required by municipal policy.) Work to Start: (II el I 2 I 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 true and complete FIRM NAME: LIC.NO.: 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: 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 si .- • low,I hereby waive this requi em. I am the(check one)❑owner ❑owner's agent. Owner/Agent / —11111111111.. g0.1.0U I PERMIT FEE:$ /10 Signature _/ Telephone No. Oift