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HomeMy WebLinkAboutBLDE-22-006485 Commonwealth of Official Use Only or tiltE. , Massachusetts Permit No. BLDE-22-007066 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.I/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:6/7/2022 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) 19 JACQUELINE CIR Owner or Tenant KIMBALL MARK W Telephone No. Owner's Address KIMBALL TIMOTHEA K, 7 FERNWOOD DR, EAST HAMPTON, CT 06424 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: Bathroom &sitting area. 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. grad. 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Euuivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Euuivalent OTHER: Attach additional detail i/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: MICHAEL P YOUNG Licensee: Michael P Young Signature LIC.NO.: 37999 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 156 CAPES TRL,WEST BARNSTABLE MA 02668 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 0°1 c, ( oCzo (� ►)tbw it Vcb/1a©N/I.S Alb r 7� L�vp�) RECEIVED '` UN 06 2022 �j / om Owes o�///aeeachuesl!fa Official Use Only ... _ � `�z2-70�t� "s,il. ft �7 Permit No. " �''`^• `'ING UEPARTME ''���o/,}irs sirwcse . -.l l:�?+_ _ _ -- _ Occupancy and Fee Checked .. .7 ip • - • • PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 94EC 527 C R 12.00 �� '' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6a 1k City or Town of: YARMOUTH To the Ins ctor f Wires: By this application the undersigned gives notice of his or her intention to perform electrical work described below. b Location(Street&Number) l9 J,¢L' (J L�L//>`/ E C/iec Ce Owner or Tenant /1,9 ,' �/ iyrl Telephone No. 77�Jly-� C \\II Owner's Address s/,15 T / rCr•v �� K Is this permit in conjunction with a buildldg permit? Yes No �` X (Check Appropriate Box) Purpose of Building Utility Authorization No. tExisting Service 7" Amps /,11i/ .2/6 Volts Overhead �Undgrd n No.of Meters / New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:1 `,�/ -- ti t f , /� ��1 ',err)/ f__ St'7 j„L( ,,/ A vi Completion of the followinKtable may be waived by the Inspector of Wires. 1}P �l.i, No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.or 1 oral �/ Transformers KVA 'Zi No.of Luminaire Outlets No.of Hot Tubs Generators KVA CA i• 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. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local D Municipal Connection 0 Other No.of Dryers Heating Appliances KW Security 3`stems: No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: 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: _ (When required by municipal policy.) Work to Start: Inspections to be recuested 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 insu c including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pen lt}'es of perjury,that thetformatlon on this application is true and complete. FIRM NAME: �itj,,,JL (-4'c•f A'l(1< (C�y,r1't ; i_ LIC.NO.: �2Y7,6— Licensee: (.97,C 4 & yi J,t, — Si nature �'�g ' , IC.NO.: (If applicable,enter"exempt"in thnse m�+ber line.) / / this.Tel.No.• 77 If /%y'ea Address: ,/s-& ( 'FS '�i f 7 L /0...e S 7- 1_) ,ir 5/W La 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)[]owner ❑owner's agent. Owner/Agent Signature Telephone No, PERMIT FEE: $