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Home My WebLink AboutBLDE-22-003246 A1,4 Commonwealth of Official Use Only Eft- Massachusetts Permit No. BLDE-22-003246 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:12/8/2021 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 FOREST GATE VILLAGE Owner or Tenant Lynn Gorey Telephone No. Owner's Address 29 FOREST GATE,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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel kitchen area and recessed lighting. 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 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ 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: JOSEPH J SMOLINSKY Licensee: Joseph J Smolinsky Signature LIC.NO.: 20093 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 791,SMOLINSKY ELECTRIC,MONUMENT BCH MA 025530791 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: $75.00 C / 1 ' t_oms+oamo+ 4 Massacksastt4 Official Use Only... A i �� -� °! .5' Permit No. -7,--3 "/.s--�'i (�[^./ I •pw t orwicoe BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev.IlO7j (leave week) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Maasaclutetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: .Dee 7 .a,,( V City or Town of: /a-rcrn a p/�j l°,art- "To the Inspector f Wires: OBy this application the undersigned gives notice of his or her intention to perform the electrical work described below. ` Location(Street&Number) 2 ? F-,,rye J y(,a-1 e v, I(tty Owner or Tenant Ly/1 h C are f, 4- 5tt c al.,sat ,s-e44.r(Cj Telephone No. J Owner's Address Is this permit in conjunction with a banding permit? Yes Er No 0 (Check Appropriate Boa) Purpose of Biding resj deg ft uz( utility Authorization Na 4 Existing Service Amps / Volts Overhead 0 Ua dgrd❑ No.of Meters . ' Q New Service Amps / Vohs Overhead❑ Uadgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a I Completion of thefttlImvMttnatle be waived by the I�t or of Wires. l No.of RecessedNo.of Cei Luminaires .(Paddle)Fours Tro ans.of m y formers KVaA T 4 No.of Luminai a Outlets No.of Hot Tubs Generators KVA AbNo.of Luminaires Swimming Pool ❑ to. ❑ Rio.bat cry Units a�g KentBattery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INa.of Zones No.of Switches No.of Gas Burners No.of Detection and Itdtiatine Devices.. IQ No.of Ranges No.of Mr Cond. Toad No.of Alerting Devices No.of Waste I Purup NumberToe*:1 ., Tons KW _ No.of ME-Contained No.of Dishwashers Space/Area Heating KW Local 0 Connedtiasa Other No.of Dryers Seating Appliances re w Security$y b No.of Water KW No.of No.of No. Da nT of air t Heaters Signs Ballasts N .ff DDevi es or :,strident No.H Bathtubs No.of Motors Total HP ' ' , No.of Da vfcas or Ed' i ,t OTHER: Estimated Value of$tectrical Wor}c .attach additional detail}'desired or as required by the Inspector of Wires. Wank to Start: /.��/ `�-� (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the including 'ge of electrical work may issueunless the licensee provides proof of liabilityinsurance „ "completed coverage or its substantial equivalent. The undersigned certifies that such c ov is in force,and has exhibited proof of same to the CHECK ONE: INSURANCE BONApermit issuing office.!cerstll►',render the patios and penalties D 0 OTHER 0 (Sp�fy;) of pes1wry,that the bijbrmadon on this applications is Owe and complete, FIRM NAME D //1,1) 1 ec fr/ Licensee: .Tv s ell I1�7, S d��N s LIC.NO.: �f�0 q3/1' tbra kabk. 'Ent axber lime) LIC.NO.: Address: . 0 13/S�! '7 9/ M n , y-�3y-uc-4i �? r).-s,.T 3 Bus.Te No.: r�u 7�s#v3 *Per M.G.L.c. 147,s.57-61,security work requiresDepartment of Public Safety"S"l i Alt<Td No.: a 7 y"__ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does notthe liability insurance Lin,No. Owner/Arequired by la By my signature below,I hereby waive this I am the(check one ■ owners$owners � ,t. Signature Telephone No. PERMIT FEE: