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Home My WebLink AboutBLDE-21-004188 Commonwealth of Official Use Only or�L a Massachusetts Permit No. BLDE-21-004188 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 Codc (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:1/27/2021 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) 39 RUBY ST Abe -9?lj—9 6 . Owner or Tenant Peter Moxyka Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appro• •t•is 4 Purpose of Building Utility Authorization No. e Existing Service Amps Volts Overhead 0 Undgrd 0 No. . /,• • 41 I. •r ' New Service Amps Volts Overhead 0 Undgrd 0 No.of r• V .....___ Number of Feeders and Ampacity • V Location and Nature of Proposed Electrical Work: Wiring of workshop addition. O Completion of the following table may be waived by 6 •: t res. No. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 9. Transformers No.of Luminaire Outlets 5 No.of Hot Tubs Generators .4 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 6 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 1 Space/Area Heating KW Local 0 Municipal ❑ Other Connection No.of Dryers 1 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: Michael F Simonis Licensee: Michael F Simonis Signature LIC.NO.: 16862 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: PO BOX 1488, EAST DENNIS MA 026411488 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 R.101.,&iit/z (Z1 Ofr_ 5t1(24 Govuvrp Lulu, ow) j Odiskleili fficial Use Only � � � Permit No.lei) 2�* -Cervices ,r, Occupancy and Fee Checked y BOARD 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).Date: 527 CMR 12.00 (1 .2 s// (PLEASE PRINT IN INK OR TYPE ALL INFORMA?70N) �� City or Town of: }�,q-2-04,9 cJS--k. To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 3 9 7(L,,,,Z. y 5 71-` Owner or Tenant Re ) 2 6-)L>1 k At- Telephone No. U Owner's Address 54-04 -d- ...1 d- t-1� nista Box) L7 [] (Check Appropriate� Is this permit in conjunction with a building permit'` Yes No�orization No. Purpose of Building GJB 04-4- S•4 -P ''' Witty Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps ) Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Wort: •?,e. v7 A t F, h s A w/2c IA.,a 2 l' ..c tSe..DP ,¢,7 I T-71 U� 41-49 a S QT table be waived by the lnpec r of Res. Completion of the following may No.of Total W No.of Recessed Luminaires No.of Cefl.-Susp.(Paddle)Fans �! Transformers KVA No.of Luminaire Outlets 6— No.of Hot Tuba Generators KVA Above In- No.or Emergency Ligating No.of Luminaires Swimming Pool erad. ❑ ted, ❑ Battery Units No.of Receptacle Outlets / S— No.of Oil Burners FIRE ALARMS jNo.of Zones `No.of Detection and ` No.of Gas Burners Initiating Devices z• No.of Switches Tota[ I U No.of Ranges No.of Air Cond. Tom No.of Alerting Devices ---sp Teat Pump Number Turas _ KW,_ N�ofSSddf-Contained No.of Waste Disposers Totals: __ Local 0 Municipaln 0 Cid"No.of Dishwashers / Space/Area Heating KWConnectio �n s:" Na of Dryers / Heating Appliances KWSecurity fDevices or Equivalent No.of Waterleo.of No.of Data Wiring: t Heaters KW Sians Ballasts No.of Device!or iri�n�•'�or ' , No.Hydromassage Bathtubs Telecomm No.of Motors Total AP No.of Devices or Equivalent --- OTHER: of Wires. Attach additional detail if desired,or as required by the Inspector Estimated Value of Electri Work: (When required by municipal policy.) Work to Start: A../ a Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 Er BOND 0 OTHER 0 (Specify:) '772--,f-c.,,-i-c-i S I mei,under die pains and penalties of perjury,that the information on this application is true and complete. LIC.xo.: .�-��_� �a • FIRM NAME: S/�a u t S JF.: cc o /C .vc�. � : T' .5'c),3.32?Licensee: , ,A�+" ) 5'`""`o'',S Signature / - /�� Bas.Tel.- LIC.NO: ' fc�Y-8687 (if applicable.enter"exempt"in the license number line.)` G t// Alt.TeL No.: Address: • o• e/x • •' `'. D c'HO D Te.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 Licensee does not have the liability insurance coverageoonwnerrmallyy required by law. By my signature below,I hereby waive this requirement. I am the(check one owner s ent. Owner/Agent Telephone No. PERMIT FEE:$ 7�'-°`' Signature