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Home My WebLink AboutBLDE-22-005078 Commonwealth of Official Use Only ;.� ►,� Massachusetts Permit No. BLDE-22-005078 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:3/14/2022 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) 29 LEWIS BAY BLVD UNIT 4 Owner or Tenant KOCH ANNE L Telephone No. Owner's Address P 0 BOX 778,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Wiring for 2nd floor addition. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 30 No.of Ceil:Susp.(Paddle)Fans 4 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. Batters/Units No.of Receptacle Outlets 30 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 25 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton 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 ❑ 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: Shawn A Souza Licensee: Shawn A Souza Signature LIC.NO.: 39768 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:31 LAKE DR, PLYMOUTH MA 023605648 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 I i (i __,Iti '51;1077)2.- e-C-- ( j " .fis12- upper cam) - I( Car -r- Oic1 4/14 / writ at il RECE vED MAR 14 ''_,._ A. l,ommontea� 4f " c� Official Use Only BUILDING D t f , epa+�renE ol.�u+e...Cervices Penult No•t _EL__- �/L iSO � BY -- BOARD OF FIRE PREVENTION REGULATIO NS ev.Occupancy and Fee Checked IAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL, I�Veblank All work to be performed ir, WORK 'PLEASE PRINT IN INK OR TYPE ALLFOR the Massachusetts Electrical Code EC), 7 cMR 12.00 INFORMAT10N1 City or Town era Date: / YARMOUTH —nTo the Inspector of Wires; By this application the undersigned gives notice of his or her intentioto .ocation(Street&Number) perform the el work described below. Owner or Tenant -�-- ` Ei I Owner's Address Telephone No. Is this permit In conjunction the ngtpennit. n ' Y purpose of Building I No 0 (Check Appro to Box) !listing Servic Utility Authorization 'a Amps /. oils Over end 0 Und (- �� Amps / Voltsgrd Cl No.of Meters _�_ Number of Feeders and Amp ty Undgrd❑ Overhead 0 g No.of Meters anon an Nature of Proposed Electrical Work: ° iVo.of Beetled Com,letlon o the allow' : table in Lr Luminaires No.of Celt-Sn°P be waived• the I taro Wires. CA No.of Lu '(Paddle)Fans `o•oKVAAll minalre Outlets No.of Hot Tubs Transformers No.of Luminaires Generators K�rq �� o.ofSwimming Pool Ve n- ❑ 'o.o 'mergency '' n Receptacle Outlets - d. ❑ Butte Units� g -„ No.of Oil Burners ;�~ No.of Switches No.otCas.Bnraers No.of Zones No.of Air Cond. IniHatln Devices o• o.of Waste Dispose Tons No.of Alerting Devices eat ump um er Totals: .._""_-.-~ ens `o.o on, l4o.of Dish rtin Devices Dishwashers Space/Area Heating KW DetectloNAle No.of Dryers Local❑ Conn p ❑ Other o o a r Heating Appliances KW , u action tY ystems: Heaters KW 'a.o `o.o No.of Devices or nivalent No.Hydromassage Bathtubs S os Ballasts Data Wiring: No.of Motors No.of Devices or divalent OTHER: Total HP a ecommu ons " r gg No.of Devices or E.uivident Estimated Value o Elec , . Attach additional detail(desired,or as required to Start: 'cal Work. O When required bymunicipal by the Ins WorkSURANCE �' Inspections to be requested in accordance pul 10 Inspector of Wires. VERAGE: Unless waived by the owner,no ewith Mor Ruleo eland upon completion. theIN'licensee provides proof of liability irrs N Pit for the undersit certifies that such covers • including completed operation" overag e or its al work may issuentunless u'f�,and has exhibitedproof ofa to theee substantialagoffice.equivalent. The CHECK ONE: INSURANCEi of same to I card,f,)r,under the Ins and BOND 0 OTHER 0 (Specify:) Spermit issuing FIRM NAM penaldes pedJu ,that the Inforni�n on dr tic don is Licensee: �� true and contplue..,� (Ifappltco m ., „_ LIC.NO.: `. ', ?(o Y pi"in the license Signs Address: ligel IC.NO.: ? p 'Per M.G.L.c. 147,s.57-61,security work �' us.Tel.No.'OWNER'S INSURANCE WAIVER; 1 requites Dap t of Public Safety It.TeL No.: pip required bylaw. Bya"'aware that the Licensee `h'"s"License: Lic.No. Owner/Agent my signature below,I herebydoes not have the liability insurance coverage normally Signature ant waive this requirement, 1 am the(check one Y Telephone No. owner / owner's a;ant. PERMIT FEE:S