Loading...
HomeMy WebLinkAboutBLDE-22-000517 Commonwealth of Official Use Only illitli Massachusetts Permit No. BLDE-22-000517 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:7/28/2021 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) 6 ELLIS CIR Owner or Tenant Richard Kaiser Telephone No. Owner's Address 6 ELLIS CIR,YARMOUTH PORT, MA 02675-1335 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: New residence 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers 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: Heaters Signs 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: MARK B KIEFER Licensee: Mark B Kiefer Signature LIC.NO.: 26093 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:53 GRASSY POND DR, DENNIS MA 026382515 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:$180.00 62._rwty 4 C/vollT- 7/2&/zi l Roda-t-, ofil SE Oct © Ls oc/crr', wtfo ,s 17Es, ejEIF 4v2YTS 'r 4 j2 4'3 76//L . 'a 1 ���' L �> 4' ' C44tu , E4CCO b. . 14 l_.ommonwsalth ol'r/aaaachuaslfa Official Use Only B: .A t Se Permit No. 2 Z fJ( 5 f '7 J !/ t ..Us/varEmsnl oi,}u srvicse Nt BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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,gMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 - Z City or Town of: YARMOUTH To the Inspector of Wires: Loca ,st By thisti applicationon(Street&theNumbe undersignedr) gives notice of his or her intenti��on toL perform the electrical work described below. p., Owner or Tenant A G 4 ed-��/ �04 t S.E'ft+ Jl Owner's Address '�/t}—�lt Telephone No. 1 Is this permit in conjunction with a building permits yes Purpose of Building C NO El (Check Appropriate Box) Utility Authorization No. 5 i e 4/[/ `'c Existing Service Amps / Volts Overhead y New Service E] Undgrd E] No.of Meters Amps / Volts Overhead❑ Undgrd Number of Feeders and Ampacity g 0 No.of Meters Location and Nature of Proposed Electrical Work: th Rp v!, tis Nil) Com.letion o the ollowin: table m be waived b the In .ector o Wires. No.of Recessed Luminaires ,,, No.of Cell.-Sasp.(Paddle)Fans °•° ota No.of Luminsuire Outlets Transformers KVA r~� No.of Hot Tubs Generators KVA' No.of Luminaires Swimming Pool ' 'ove n- •o.o mergency g ng• ❑ _� nd. ❑ Batte Units g No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners `o.o t etec on an i r No.of Ranges Initiatin_ Devices No.of Air Cond. ota Tons No.of Alerting Devices No.of Waste Disposers `eat 'ump `um,er ons ' Totals: o e - onta ne No.of Dishwashers Detetection/Alertin. Devices Space/Area Heating KW Local❑ 'un c p No.of Dryers Heating Appliances ecu Connection ❑ �� `o.o "a er KW yevices o.o . No.of Devices or E s uivalent Heaters ' ° ° Data Wiring: Si ns Ballasts No,of Dvices or E s uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommun ca ons •" r g; No.of Devices or E s uivalent OTHER: Estimated Value of Electrical Wp rk: Attach additional detail ifdesired or as required by the Inspector of Wires. Work to Start: 7 -� 1ons (When required by municipal policy.) p P° � Y) INSURANCE COVERAGE: Unless waivedby to the oe gwner,no permit uested in accordance the performance of 10, lectrical wok issueayti the licensee provides proof of liability insurance includingmay ent. unless undersigned certifies that such coverage is in force,and has`exhibited proof of same to the permit issuing coverage or its toffieuivalent. The CHECK ONE: INSURANCE 69 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of penury,that the information on this application is true and complete FIRM NAME: Licensee: ka be /2t e ,P� Signature LIC.NO.: (If Address: able,ettr"e mpt" 'nlhglicense LIC.NO.: G Address: J S 5� n , �ine. x *Per M.G.L.c. 147,s.57-61,security work require .h7p Bus.Tel.No.• OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityAlt.TeL No.:Department of Public Safety"S"License: Lic.No. .------- OWNER'S by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent insurance coverage normally Signature � owner ■ owner's a:ent. Telephone No. PERMIT FEE:$