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HomeMy WebLinkAboutBLDE-22-000568 Commonwealth of Official Use Only fi Massachusetts Permit No. BLDE-22-000568 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:8/1/2021 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) 71 WHARF LN71'/x 9'f 3 r 4 q Owner or Tenant Jon Petersen Telephone No. Owner's Address 71 WHARF LN,YARMOUTH PORT, MA 02675-1141 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: Remodel to add bathroom. 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. 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 Initiatine Devices No.of Ranges No.of Air Cond. TotaloNo.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 Equivalent No.of Water KW 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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: $75.00 I Zure4/ ( '2 k V.244/ 1 Z W 2 f� > 1 ct`~-. 1 t Q C Official Use Only �' I cV I i ommonwea aeeac aesitd w 1 "7 n Permit No —22 (0 is �.: � 1sparimsnt 01.. irs Servicse ()i "-7j !k li _ Occupancy and Fee Checked Lij `• BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) LE. 33 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 3 0 /o4 1 City or Town of: YARMOUTH To the Inspe for ofWires: By this application the undersigned gives notice of his or her" .ention to perform the elec cal work described below. Location(Street&Number) 7 // n Owner or Tenant j-0,1C . p f-e r.S e i Telephone No.7 7 r3/3 (J 2.5-7 Owner's Address �a ane Is this permit in conjun on with abuilding permit? Yes No 0 (Check Appropriate Box) Purpose of Building e /�t'/2 G e._ uthoriza tion No. Existing Service 4,4' Amps C<.2. Volts Overhead Undgrd ❑ No.of Meters / New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: f/eln 4 l itt' ok( c h4 4 A r-,..,,, vi V Completion of the followingtable may be waived by the Inspector of Wires. Traa onsformers KVA LbNo.of Recessed Luminaires No.of Ceil.-Snap.(Paddle)Fans No fTotal 1:Z3 No.of Luminaire Outlets No.of Hot Tubs Generators KVA t1 No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting Qrnd. ❑ 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 III No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Totals: Pump Number Tons ..._. KW No.of Self-Contained Totals: "" "�Y� Detection/Alerting Devices No.of Dishwashers S ace/Area HeatingKW Municipal Space/Area I'oc�❑ Connection ❑ No.of Dryers Heating Appliances KWSecurity Systems:'i No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs 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 lectr'cal Work: 6 eo. (When required by municipal policy.) Work to Start: - 07 t Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C 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 0 BOND 0 OTHER 0 (Specify:) I certify under thein and penies of perjury,that the information on this application is true and complete. FIRM NAME: ,--9 On ! e Te r j eA p LIC.NO.: Licensee: Signature L (If applicable,enter'gxem,Pt"in the li number line.) 't'� LIC.NO.: Address: r7/ GJna r t4-a oe � 1i�4,(,�' Gli)'��j{� f 74- b./ L- Bus.TeL No.. 7 y ). j q *Per M.G.L.c. 147,s.57-61,security work requires t)tpartm of Public Safe ©"License: Alt.TeL N . OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability i 'ranee coverage normally Owner/Agentrequied by By my• s;... : , ' low,I hereby waive this requirement I am the(check one ti/ owner ■ owner's a:ent. Signatuiiji A_,j/ Telephone No77t'.3/3Q,3- PERMIT FEE:$ I