Loading...
HomeMy WebLinkAboutBLDE-22-006161 tis . Commonwealth of Official Use Only 1` Massachusetts Permit No. BLDE-22-006161 I G BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:4/26/2022 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) 18 SIERRA WAY Owner or Tenant SIERGIE DONALD Telephone No. Owner's Address SIERGIE MAUREEN, 3 BAINBRIDGE RD,WORCESTER, MA 01602 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: Generator with transfer switch. 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 1 KVA 8 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalonNo.of Alerting Devices TNo.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 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 Ballasts Data Wiring: HeatersSiens 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 R Devine Licensee: Michael R Devine Signature LIC.NO.: 21319 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:20 LITTLE MICAJAH PND RD, PLYMOUTH MA 02360 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. ' '. EE: $50.00 J _� Izv i t cL`/d/�i ©tile/vb 6/dc 5U7 - ,CEiVED ; r_...,.. ,,,. [ APR 25 IrCommonwealth o f///aaaachudatie Official Use Only BUILDING UE -u, _=t} �L 1sparttmsnt.`..firs_ca. Permit No. �� (a B - (� 4 Occupancy and Fee Checked 'ii,„4e` 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 (ME ) 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L 7_5- ze -z-Z--- City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfo the electrical work described below. Location(Street&Number) 0 i-6 C-N1 \t.M i C I Owner or Tenantrn i',,� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No Ea (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service/0-0 Amps 17_a) / 14.(2Volts Overhead® Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty r Location and Nature of Props Electra 1 Work: , ,n \-,,,_t C 1-ct-0 - C £_ I i - Completion of thefollowin&table m be waived by the In ector of Wires. %4Vv ayInspector ill, No.of Recessed Luminaires No.of Cell.-Sos No.of Total r r p.(Paddle)Fans Transformers KVA "4 No.of Luminaire Outlets No.of Hot Tubs Generators C6 KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting /rod. grnd. Battery Units F No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS INo.of Zones ~ ` No.of Switches No.of Gas Burners -No.of Detection and << — Initiating Devices No.of Ranges No.of Air Cond. T nsl No.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons J KW No.of Self-Contained Totals: ] _Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipid Connection 1--1 other No.of Dryers Heating Appliances KW Security Systems:* - No.of Water No.of Devices or Equivalent KW No.of No.of Data Wiring: Heaters Signs Ballasts Na 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 41 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: lllG�o�„� LIC.NO.: Licensee: r A/ Signatures LIC.NO.:7i17-51(17— (If applicable,enter" empt"in the!jeepsnum e t .) Address: ,Pe i1+' ;t'.1)1~ec��u 1-� (�)Y t,�,�� Bus.Tel.No.• ".'.• . D *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No. •7 2 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 ■ owner ■ owner's a• Owner/Agent Signature Telephone No. PERMIT FEE:$ Ua:ent. —