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HomeMy WebLinkAboutBLDE-22-006607 Commonwealth ofPI\ Official Use Only fi Massachusetts Permit No. BLDE-22-006607 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:5/17/2022 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) 141 HIGHBANK RD Owner or Tenant Steve Sullo Telephone No. Owner's Address 141 HIGHBANK RD, SOUTH YARMOUTH, MA 02664 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: Rewire 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 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 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 ❑ 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: Roger Poitras Licensee: Roger Poitras Signature LIC.NO.: 14319 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 176, ROCHESTER MA 027700176 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 ZZJjeet* 9z-0_,A0Z-,--, q(€3171, ' e,2 di,-..cV2( /w T70 -( - r ê/ oachuietLi Official Use____ Lommonwealy Only1 R E 'f# ' - t�D c� c7 Permit No. 62�--Coco,0-7 =�1_ Apartment o/.}ire Serviced =�-�= Occupancy and Fee Checked MA '», , BU �_ 2 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) �I-LDING D APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK sy. 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: - / 6 v.2 dot )- City or Town of: 'y4 4 r1©(171 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) / L// Al/ G H 64 kJ f A a . Owner or Tenant S/ ) C.- S t1 L L Z:, Telephone No. Owner's Address I Lf l Hi G Ff 6 4 ki< <a Is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box) Purpose of Building ACS f Si,"bile.. Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service a(JU Amps /old/a inoVolts Overhead li-k-- Undgrd ❑ No.of Meters j Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A a> /,z e /s4.79,00,.. Completion of the following table may be waived by the Inspector of Wires. N r KVA Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tr of Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting 3 grnd. grnd. Battery Units No.of Receptacle Outlets a No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of AlertingDevices 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❑ Municipal ❑ Other Connection _ No.of Dryers Heating Appliances KW SecuritySystems:* 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: /000, COI (When required by municipal policy.) Work to Start: S=/‘ Q,1) 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 [Ie'BOND ❑ OTHER ❑ (Specify:) I certify,under the painAs and penalties ofperjury,that the information on this application is true and complete. FIRM NAME:K i/', Le c j Z l( _ 04 L'✓� LIC.NO.: /y 3/,,f. Licensee: 4 d G ea_ A fl it,4 f Signature 407 Ca..... .... LIC.NO.:/9?/ , (If applicable,x�nter "exempt"in the license number line.) Address: //,D. /j0 X. 7 6. ✓lac ff eS rc/Z r7/4. 77 Bus.Tel.No.:sag?�8 7 y3 � Alt.Tel.No.: *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. /4/3/14 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 Signature Telephone No. I PERMIT FEE: $ '7S',0O I