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HomeMy WebLinkAboutBLDE-22-001966 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-001966 J Occupancy OF FIRE PREVENTION REGULATIONS P Y 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) D ate:10/6/2021 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) 107 MERCHANT AVE Owner or Tenant Jon Fish Telephone No. Owner's Address 107 MERCHANT AVE,YARMOUTH PORT, MA 02675 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring for shed. 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 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches 2 Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices i Space/Area Heatn Local ❑ Municipal No.of Dishwashers P g KW Connection ❑ Other: HeatingAppliances KW Security Systems:* No.of Dryers PP No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: No.Hydromassage Bathtubs No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. required bymunicipal policy.) Estimated Value of Electrical Work: (Whenq P P Y. 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: LIC.NO.: 56661 Licensee: Tsanko Vasilev Kichukov Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: o. 5083677208 Address:90 Captain CHase Road,South Yarmouth MA 02664 *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 0 owner CI 's agent. signature below,I hereby waive this requirement.I am the(check one) I Owner/Agent 'PERMIT FEE: $125.00 Signature Telephone No. ...ria,jet..1 04 tO kik - l4 (k0(: - �,rerreowevatLiaeasessf#s EJfficial Use Daly �-� —�Q(o,• „�� Permit No. l�/22' � `.�sparfwetwt��Jerrvrese r Occupancy and Fee Checked 9 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) jam" « v APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEy ALL INFORMATION) Date: /0. L7/•,f 01/ City or Town of: .✓c?ru.,c.4v�4 To the Inspector of Wires: By this application the undersigned gives notice of his or her intian to perform the electrical work described below.l N. `,�/ (,� Location(Street&Number) /Q ,' 'c ?4 z rJ , 'e1 a r►'i OZ/-4 t 1?2 • �`�/� V owner r Tenant J p n Fl S e) Telephone No. 5o$ -4,9h -n 2// Owner's Address /c Z /tVe r,hc?/'I/ ,4've . "Y',/rGu 4 c./76 /73 r-, s /VA Is this permit in conjunction with a building permit"? Yes © / No E (Check Appropriate Box) Purpose of Building Utility Authorization No. V Existing Service Amps / Volts Overhead❑ Undgrd Q No:of Meters C New Service �r._.__. Amps / Volts Overhead 0 Undgrd El No.of Meters. `J Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,Si) I o W e 0 4 f e S el eel r1.0 d •. wfil cfpc 1 ututnakccs 1 ' ecep+acre Completion Ithe fallen utg table may be waived by the Inspector of Wires. No.of Total LA No.of Recessed Luminaires No.of CelL-Soap.(Paddle)Fans Tnnsformen KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA iCN Above In- too.of a:mergency Lighting -4� No.of Luminaires p Swimming Pool turd. 0 und, 0 Battery Units :-.,/1 No.of Receptacle OutlOutlets (2 No.of Oil Burners FIRE ALARMS No.of Zones ofnd No.of Switches 2 No.of Gas Burners No.Initiating Dnevices 1 l No.of Ranges No.of Air Cond. Ty No.of Alerting Devices No.of Waste Disposers Heat P Numb ;Touts Kw — Detection/Alerting of Self-Contained ection/Alerrting Devices No.of Dishwashers Space/Area Heating KW l D Courser econ © Either Security Systems:* No.of Dryers Heating Appliances KW No.ofDevices or Equivalent No.of Water ` No.of 1+to.of Data Seaters SUP' Bum"' No.of Devices or Bq t No.Hydromassage Bathtubs No.of Motors Total HP Tel f Ect t OTHER: Attach additional detail if desire d or as required by the Inspector of Wires. Estimated Value of Electrical Work:42 5 tom, 0,0 (When required by municipal policy.) Work to Start 10. 0 g3../0,1I 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 pert ,that the information on application is true and complete. FIRM NAME: �7c?r 2 / e zek-02 c/ LIC.NO.: crj cj�'cCv I` U Licensee: -1-&av t V;C P u 1►o tI Signature LIC.NO.: 54 c 0/ b (If applicable,enter"exempt"in the license number line.) Ii Bus.TeL No.: Address: . 10 seta I tel C e a Se �� S . a Cu' C - M Cr Alt.Tel.No.: *Per M.G.L.c. 147,s. 7-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not how the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)[I owner �]owner's agent. Owneragent Signature Telephone No.50 5-3 for.toi PERMIT FEE:$ —