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HomeMy WebLinkAboutBLDE-21-001605 Commonwealth of Official Use Only (It ,� Massachusetts Permit No. BLDE-21-001605 , 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:9/28/2020 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 99 BERRY AVE ` 17.A nl' S(= Owner or Tenant lephone No. Owner's Address , 99 BERRY AVE,WEST YARMOUTH, MA 02673 t Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropr : 'o. l Purpose of Building Utility Authorization No. 3 Existing Service Amps Volts Overhead 0 Undgrd 0 U ki et . b `► New Service Amps Volts Overhead ❑ Undgrd 0 of III 4> q WM. Number of Feeders and Ampacity ® 4v r''t Location and Nature of Proposed Electrical Work: Total renovations. i'llP Completion of the following table may be waived by the n Jr. ' 'res. No.of Recessed Luminaires 10 No.of Ceil.-Susp.(Paddle)Fans No.of To . 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 110 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 22 No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 8 Totals: Detection/Alertine Devices No.of Dishwashers 1 Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 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 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Richard L Serpone Licensee: Richard L Serpone Signature LIC.NO.: 6910 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 183 PINE ST,YARMOUTH PORT MA 026752374 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 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: $460.00 (`'"1 oe -- ivz- 0 0 b✓ /200:... /3 n4t_-iv / rZ/31r1) p&u2 .1 /24171 Dc p, /2i4/2C �— aa`` Official Use Only --Y Commonwaat'th o��aeeaclzu�a(7;! O i�` _l� �� c� Permit No. �..� �+�- . )epartmanl o`Jiro Services '� Occupancy and Fee Checked .4 A 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 TYPE ALL INFORMATION) Date: City or Town of: X,w/o,.'01 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the t gi electrical work described below. Location(Street&Number) `j 9' /, Pry ,y✓e VA- f y9r�c,./� Owner or Tenant J •tc...kr _cr r/rt� Telephone No. Owner's Address / 4, ,-„, "49 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building fJ w'e/4 Hf Utility Authorization No. Existing Service A'c' Amps j4? l aos'v Volts Overhead©---- Undgrd❑ No.of Meters New Service Amps / Volts Overhead l l Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work.: (..„(y,'r/,,,� t,. /v,4/ ri'Y`*9c'el1a, s, n Completion of the following table may be waived by the Inspector of Wires. No.of Total J No.of Recessed Luminaires /0 No.of Ceil.-Susp.(Paddle)Fans Transformers KVA � CI No.of Luminaire Outlets No.of Hot.Tubs Generators KVA ga Above In- No of Emergency Lighting �k No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units 1 J CNo.of Receptacle Outlets /'U No.of Oil Burners FIRE ALARMS No.of Zones -t I No.of Detection and No.of Switches ,,Z No.of Gas Burners Initiating Devices r IL! No.of Ranges No.of Air Cond. Toosl No.of Alerting Devices 'Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers p Totals: Detection/Alerting Devices 9 No.of Dishwashers / Space/Area Heating KW Local❑ Connectioncf ❑ Other No.of Dryers / Heating Appliances KW Security Systems:* ry No.of Devices or Equivalent (No.of Watery No.of No.of Data Wiring: Heaters 6 ei Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsofDevicesor Wiring: y g No.of Devices 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 EKBOND ❑ OTHER ❑ (Specify:) I certify, under the poi nd penalties of perjury,that the information on this application is true and complete. FIRM NAME: .,� t Sir <,Y- LIC.NO.: /te 9/o Licensee: '�� Signature i,/Ge-c� �. j r' LIC.NO.: z=/66 cry (If applicable,enter'exen in the license number line.) i Bus.Tel.No.•Ce'0- See gat Address: /•?) dtKei e >/ Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires 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)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No.