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HomeMy WebLinkAboutBLDE-23-000284 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-000284 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:7/19/2022 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) 68 SALT BOX RD Owner or Tenant Peter Noone Telephone No. Owner's Address 68 SALT BOX RD, SOUTH YARMOUTH, MA 02664-2326 Is this permit in conjunction with a building permit? Yes 0 No 0 Purpose of Building Utility Authorization = �l� Existing Service 100 Amps Volts Overhead 0 Undgrd [ New Service 100 Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace service. 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- ❑ No.of Emergency Lighting grnd. rnd. 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 Initiatine Devices No.of Ranges No.of Air Cond. To No.of Alerting Devices 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 ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water Kit 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 ❑ OTHER 0 (Specify:) !"`tia y) 606- 922,-t'C/i I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: James A Knox Licensee: James A Knox Signature LIC.NO.: 9629 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:236 WEST 26TH ST,RM 603,NEW YORK NY 100016789 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: $50.00 QA 9- C,ommonweaaft.o/7aaoackaettd Official Use Only 1% = !/ c� .7-ire C� Permit No. a2-3 j � 2 eparts tent oi. -ire Jervice3 I f ' Occupancy and Fee Checked -; ;` 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),527 CMR 12.00 (PLEASE PRINT IN INK OR TYtPE ALL INFORMATION) Date: 1-(4-aa City or Town of: Qr rr Our.-l-h 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) l9 S Su 14 h nx, Qct Owner or Tenant P__Q44',r 1\S cone , Telephone No. Owner's Address )(17f11 E✓. Is this permit in conjun . n with a building permit? Yes 0 No 0 (Check Ap ropriate Box) n Purpose of Building E S 1 Ci r?rrt-a) Utility Authorization No. `1(pa P_I Existing Service Ari)Amps (a()/ Volts Overhead Dr Undgrd❑ No.of Meters 1 New Service \� Amps 'c) ©Volts Overhead F Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: V-‘19--P date_ A)iLe_. Completion of thefolowin table may be waived by the Inspector of Wires. -No.of Total No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In-. No.of Emergency Lighting No.of Luminaires Swimming Pool grad. ❑ grad. o Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.onDeteInitiating and Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat-Pump Number[Tons KW No.of Self-Contained als: Detection/Alerting Devices Mal No.of Dishwashers Space/Area Heating KW Local 1:--IConnectunicipion ❑ Other Heating Appliances 'Security Systems:* No.of Dryers g KW No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring. No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: .- Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: c)t ()CO, — (When required by municipal policy.) Work to Start: ( 1 g pa- Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: 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 gains and: nalties ofperjury,that the information on this application is true and complete.330a A 1 FIRM NAME: a • . . _c I , LIC.NO.:A(�Lo Licensee. gf ! '� , �� LIC.NO.��r Signature � , (If applicable,enter"exemp in the cense number line. l Q�, Bus.Tel.No.: Address: I'D 10C � 50 t i l Niel�K J Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"L4thetS- 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)0 owner ❑owner's agent. Owner/Agent I PERMIT FEE:$ Signature Telephone No.