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HomeMy WebLinkAboutBLDE-22-000806 Commonwealth of Official Use Only 4)41% Massachusetts Permit No. BLDE-22-000806 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:8/12/2021 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) 8 ICE HOUSE RD Owner or Tenant DONGELEWIC BRIAN J Telephone No. Owner's Address 8 ICE HOUSE 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: Air Cond. 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. 1 ,Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons J 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: JOSEPH V SLOWEY Licensee: Joseph V Slowey Signature LIC.NO.: 11186 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 168 WATERCOURSE PL, PLYMOUTH MA 023603629 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:$50.00 , Pz-fq-bY „ REcEi Eo cia,Useonly jt ►<. c cc77� Permit No. �Z�2 i� 6 0(, AUG I. .LJspwrias si q...t r Serviced W Occupancy and Fee Checked BUILDING D" ,_,'MENr OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) By. __ ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK o All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 u __ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: - /U 0)/ City or Town of: Yet(win i To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work descri below. Location(Street&Number) /e.e. hv&i, j Jed (j�bx/�� r"aii nor,'1 v1 Owner or Tenant f r/Q f �r p ).e w C / Tele hone No. !n � 1 P u'��' G/Q 7i y� V, Owner's Address 1 Is this permit in conjunction with a building permit? Yes 0 No 51. (Check Appropriate Box) Purpose of Building Res den C . Utility Authorization No. SExisting Service Amps / Volts Overhead© Undgrd 0 No.of Meters New StrvJce Amps / Volts Overhead© Undgrd 0 No.of Meters Number of Feeders and Anspaclty Location and Nature of Proposed Electrical Work: G F! Ale., ctl/S C'o/1�t?c f 1 ©uTI F t Completion of the followin:table may be waived by the Inspector of Wires. 13) No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fans Total Transformers KVA iZi No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. Luminaires SwimmingPool Above In- No.of Emergency Lighting fiend. © �,d © Bntterr Unit• No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices I L.I No.of Ranges No.of Mr Cond. Too T No.of Alerting Devices No.of Waste Disposers Hestl� Number...Tons__ _KW. No.of Self-Contained Detectiion/AlertiniDeoices No.of Dishwashers Space/Area Heating KW Local 0 Municip nnection 0 Other _ Co No.of Dryers Heating Appliances KW Security Syystems•4 No.of Devieem or Equivalent No.of Water , 'NO.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices orEquivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunica$ons No.of Devices or EMI ant OTHER: _ Attach additional detail if desires or as required by the Inspector of Wires. Estimated Value,of Electrical Work: (P 5 , (When required by municipal policy.) Work to Start: g•jo.a/ 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 BOND 0 OTHER 0 (Specify:) I certly,under the pains and penalties of perjury,that the bformadon on this application is true and complete. FIRM NAME: j v S I e Ccr I <t e, n LIC.NO.: License*: i 5 l o---�,'e `-'1 Signature iv/ G -fix 6/ LIC.NO.: ///et, (Ifapplicable,enter"exempt"in the lice►yte number l ) Bus.Tel.No.;.5 ', .. 4:' `-'1 84 Address: /%8"wafer thir3e /l acL . Hy/wadi'', `k '-• o'3 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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 50'