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HomeMy WebLinkAboutBLDE-21-007494 5V\ ,j Commonwealth of Official Use Only '✓ Permit No. BLDE-21-007494 ,� . Massachusetts 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:6/24/2021 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) 29 GROVE ST Owner or Tenant OLSEN ROBERT G Telephone No. Owner's Address OLSEN HELEN M, 7 WOODLAND PL, GRANBY, CT 06035-2520 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: Wiring of addition on rear of house. Completion of the following 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 ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ In-grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices Local ❑ Municipal 0 Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent NoNo.of No.of Data Wiring: He Water KW Signs Ballasts No.of Devices or Equivalent Heaters 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: (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: Sherwood E Lewis LIC.NO.: 11503 Licensee: Sherwood E Lewis SignatureBus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:PO BOX 283,YARMOUTH PORT MA 026750283 *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 I PERMIT FEE: $75.00 Signature Telephone No. et/c,rV -6, Nrpie (rei(7,f � �. �— ' Al $ °? ' l.onrmonw.aAh o`l//aeoachae.tte Official use only 2epartment el girds ds Permit No. oviets r+ A. 4 Occupancy and Fee Checked ' _./ BOARD OF FIRE PREVENTION REGULATIONS [R ce cups ] (leaved Fee lank) 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:,N/)e, 2.0 2 I N, City or Town of: !n/nn.►.Aflu To the Inspector o Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 21 G rev, Sfree 4- It.-e5fi YArf,d.ntI P7Git 02b73 �,"— Owner or Tenant i ,Q(* pi$n^ T ephone No. Owner's Address 2 ? GruV•G 5 fre I- ie54- rt.,.f li p^4 2 Po 73 ri VIs this permit in conjunction with a building permit? YesNo ❑ (Check Appropriate Box) W Purpose of Building ,S(,kpryh er /ZeeSt`2(Ate, Utility Authorization No. 1 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters kNumber of Feeders and Ampaclty Location and ,,Nature of Proposed Electrical Work: '' al' • (At. •i.. Le 4. t- •• it Pl AS ft JA/K'o WIN ©A 4-6. 1-A e. ,s e_. A'0 t EvutSe , Completion of the followinttabk may be waived by the Inspector of Wires. t f No.of Recessed Luminaires No.of Cell. (Paddle)Fans No.of Total -S�• Transformers KVA �1 No.of Lumiaaire Outlets No.of Hot Tubs Generators KVA Above In- o.of Emergency Lighting No.of Luminaires Swimming Pool Ern& ❑ l fund. ❑ Battery Units J No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches O.of Gas Burners -No.of Detectionn and � Initiating Devices I U No.of Ranges No.of Air Cond. Tuns No.of Alerting Devices No.of Waste Heat Pump Number Tons KW . . No.of Self-Contained Totals: .-" __. __._ _._.____._. _._._. Detection/Alertiqgpevices No.of Dishwashers Space/Area Heating KW Local❑ 110'innattlioain0 other No.of Dryers Heating Appliances KW SecuriNo. f Devic Systems s•or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Egi�uivvaalent No.Hydromassage Bathtubs No.of Motors Total HP Tel of Devicesro Emmunications quivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o E1 'cal Work: (When required by municipal policy.) Work to Start: 2. Inspections to be requested in accord4nce with MEC Rule 10,and upon completion. INSURANCE VE GE: 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 61 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: S4heA—oD(, Lew S Signature /9U (2)L. LIC.NO.: o F' (Ifapplkab enter"exempt"in the lie number line.) Bus.Tel.No.• �j't� i 33 Address: � L I 0. j o & 6 03 / je 'q/1t".S Oefti,flc� 02 �03/ Alt TeL No.: *Per M.G.L.c. 147,s.57-61,security work r uuires 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 signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent ( PERMIT FEE:$ Signature Telephone No.