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HomeMy WebLinkAboutBLDE-22-000234 Commonwealth of Official Use Only 1�L e Permit No. BLDE-22-000234 � Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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:7/14/2021 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) 26 IROQUOIS BLVD Owner or Tenant Pam Madera Telephone No. Owner's Address 26 IROQUOIS BLVD,WEST YARMOUTH, MA 02673 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 ❑ 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: Septic pump&alarm 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 ns No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 1 Totals: Detection/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other: 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.H dromassa a Bathtubs No.of Motors 1 Total HP Telecommunications Wiring: y g 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: John M Pimental Licensee: John M Pimental Signature LIC.NO.: 27968 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 1158 E FALMOUTH HWY, EAST FALMOUTH MA 025365455 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: $50.00 I Acei 9/t54-1 W. ,--- - - .1 % Commanusaah olif ngsmachuosits Official Use Only 'I,,.t. ° Permit No.e.-'2.-7, - 0 2-34 ' ils - 2epartment el giro Seruiceit 11/4 . BOARD OF FIRE PREVENTION REGULATIONS [ReOccuv. 1177]cy and Fee Checked ' (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: YaArrAo%At_ 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) c; (o ':1:r V 00 ts a iv 1) we 6÷ Yot,rtito v 414 Owner or Tenant ?tmA Mit ette.4-44_.. Telephone No. Owner's Address ccrie Is this permit in conjunction with a building permit? Yes 0. No [3' (Check Appropriate Box) It Purpose of Building eb..etA,.eA t.Zr.i Utility Authorization No. IExisting Service Amps / Volts Overhead El Undgrd 0 No.of Meters I. New Service Amps / Volts Overhead 0 Undgrd El No of Meters Number of Feeders and Ampacity Locadon and Nature of Proposed Ekctrical Work: t4i 1 re 5".6e,,j_f c.. Ptj iii P ,4" 14,16vr iyi t. Completion of the followinglable in be waived by the Inspector of Wires. ‘.rt No.of Total Li) No of Recessed Luminaires No of Celt-Snip.(Paddle)Fans Transformers KVA No of Luminaire Outlets No of Hot Tubs Generators KVA c.‘ Above r. -1 In- IVO.of Emergency Lighting Na,No.of Luminaires Swimming Pool u d. d. 0 B mit grn grn attery ts No of Receptacle Outlets No of Oil Burners FIRE ALARMS No.of Zones -t- K.of Detection and ,-, No of Switches No of Gas Burners Initiating Devices ' Total•'t I No of Ranges No of Air Cond. No of Alerting Devices Tons ' Heat Pump Number Tons KW No.of Self-Contained No of Waste Disposers Totals: Detection/Ale t ,, Devices r-i Mun . , No of Dishwashers Space/Area Heating KW Local Li connection 0 Other No of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No of No of Data Wiring: KW Heaters Signs Ballasts No.of Devices or EpilvaIent unic No Hydromassage Bathtubs No of Motors Total HP Tekcomm No.of Dationsevices or Eq nt 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: 1-134D1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERACt: 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 (21'.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: LIC.NO.: Licensee TS rikti m Pi/h -eA, 1-7‘4 Signature 44,04_,,,,, LIC.NO.:.2 7 9 6 I I Of applicablpenter"exempt"in the I' number line) Bus.Tel No.:-Cog 5'4/.., ii V 7 2_ Address: O 3 4,4 .. , iitiS‘ 610(j/ 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 bylaw. 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. I PERMIT FEE:$