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Home My WebLink AboutBLDE-23-000941 i Commonwealth of Official Use Only L.0l Massachusetts Permit No. BLDE-23-000941 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:8/22/2022 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) 15 CAPT NICKERSON RD Owner or Tenant WILCHYNSKI MATTHEW E Telephone No. Owner's Address 15 CAPT NICKERSON 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: Remodel kitchen 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. $rnd. 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 ❑ 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: William H Allen Licensee: William H Allen Signature LIC.NO.: 13699 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:35 CAMMETT WAY, MARSTONS MLS MA 026481508 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 RO)Ureet ç/23/J2 'W 73LBL . SDE-73-7-37ly k— ro iLf ..z 6 RECEIVED 'i ...._,.. 14 mnaltaaagoA a us41a Official Use Only 8 ' Permit No. �3-'6,it 1 _-Ili y r kid ..'.If7 V BOARD O�Flrtt NtitVENTION REGULATIONS Occupancy and Fee Checked ' IIIjRev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( 'EC),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION)(-4 Date: 02� p� City or Town of: YARMOUTH To the Ins ector f Wires: By this application the undersigned gives notice of his or her Aintentio o perform the electrical work described below. Location(Street&Number) IV/ `�� r 71 Owner or Tenant 1 - ,! Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No `, Purpose of Building 0 (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd E] No.of Meters New Service Amps / Volts Overhead d; Number of Feeders and Ampacity ❑ Undgrd❑ No.of Meters 'Ti Location and Nature of Proposed Electrical Work: lei A Com letion o the ollowin table m be waived b the In ector o Wires. r!s No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans °•° ota No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA :‘. No.of Luminaires Swimming Pooi ove ❑ n_ o.o 'agency g mg No.of Receptacle Outlets rnd. nd. ❑ Batte Units No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etec on an d 1.r No.of Ranges InitiatingDevices No.of Air Cond. ota Tons No.of Alerting Devices eat ump um er ors o.o e - onta ne No.of Waste Disposers Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Cun c pa Ell OtherNo.of Dryers Heating Appliances KW ecu ty, stemstion o.o a er o o No.of Devices or E uivalent Heaters KW °•° Data Wiring: Si ns Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommun ca ons g OTHER: No.of Devices or E uivalent ___ Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o Elec deal Work: ed municipal policy.) Work to Start: " Inspections to be reque ted in accoren dan eywith MEC Rule 10, and upon comp INSURANCE OVE GE: Unless waived by the owner,no permit for the performance of electrical work mayelectricalis issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND 0 OTHER :) I certify,under the pains and penalties o er u that the information on on this application is true and complete. FIRM NAME: f p ry, PP p Licensee: LIC.NO.:j2 (lfapp/icable,enter"exem Signatur Address: p t re n tuber ire.) LIC.NO.:/ �/ us.Tel.No.:{ -- . 77-, • .- *Per M.G.L.c. 147,s.57-61,security orlc requires Dep artment of Public Safety"S"License: Alt.Tel.No.:OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�' required by law. ByLic.No. Owner/Agent my signature below,I hereby waive this requirement, I am the(check one g ally Signature owner ■ owner's a:ent. Telephone No. PERMIT FEE:$ -75-, �(t). tr. 0. ( 2 6�"� z A � 7 t55 zro.�a-►a . i� ► k Pr-64 c®n-, ,5I r( Qo .?.CD e it +6'Z '4, c r� 0 O� S /• �,�.