HomeMy WebLinkAboutBLDE-22-007128 o+.�.r Commonwealth of1 Ai
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Official Use Only
Massachusetts Permit No. BLDE 22 007128
° BOARD OF FIRE PRT VENTION 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)TION) Date:6/9/2022
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) 484 WILLOW ST
Owner or Tenant NSTAR Telephone No.
Owner's Address P 0 BOX 270, HARTFORD, CT 06104
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: Two A/C systems, receptacles, lighting, switches, & data comm.
Completion o/'the Jollowing 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 8 Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting 2
grnd. grnd• Battery Units
No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 4 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: 2 5 Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water 1 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:
t No.of Deices or Equivalent
OTHER:
Attach additional Mall a/ tesrred, or as required he 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 Ior the performance ol'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 OTI IE:R 0 (Specify:) 8 1561
I certi/y,under the pains and penalties o/'per uer,that the information on this application is true and complete. � ��
FIRM NAME: Timothy 0 Rock
Licensee: Timothy 0 Rock Signature
1 applicable,enter"e.cemin"in the license number line./ LIC.NO.: 21846
U aPI
Address:23 Monroe St, Westport MA 027902308 Bus.Tel.No.:
*Per M.G.L.c. 147,s. 57-61.security work requires Department of Public Safety"S" License: Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the License duos not have the liability insurance coverage normally required by law. But my
signature below. I hereby waive this requirement. ' am the(cheek one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No.
rEI7,11 T FEE: $100.00
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BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
• Rev. 1/07l (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: 4 /�{fr e)a,
City or Town of: 4-,e 'yl0 U T/' To the Ins�pec ofWires:
By this application the undersignedgives notice pf his or her intention to perform the electrical
W y &Jl//9t �, work described below.
Location(Street&Number) 3 /�,,C4,)o U7-�j ��, Dad 73
Owner.or Tenant ,EI/T' ,S 0 0,1 Telephone No.
Owner's Address Pa 6oX ?7d, / -/2rcL e et' D6/0
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building eG/Y/f)9. i /'C 4 L_ Utility Authorization No,
Existing Service ke,U Amps / j /a0,49 Volts Overhead 0 Undgrd No.of Meters /
,New Service Amps -,----/----- Volts Overhead-9--- Undgrd.❑-----No.of Met,.a
Number of Feeders and Ampacity /A•
Location and Nature of Proposed Electrical Work: T -GC. fOl iJlyl2 /=pK - 4C 1N"t 1 ''
R ePLf z i6/47iv/rr/ -/ . iTc,,,,-ES v_),9-7 .f` 9C',s_
Completion of thefollowlngttable may be waived by the Ins for of Wires.
No.of Recessed Luminaires No.of Ceii.-Susp.(Paddle)Fans No.of Inspector
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires e Swimmin pool Above In- -No.of Emergency Lighting
g brad. grad. Battery Units v2.
No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS JNo.of Zones
No.of Switches zi No.of Gas Burners No.of Detection and
Initiating DevicesT
No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices
No.of Waste Disposers Heat Pump(Number t Tons KW Wo.of Self-Contained •
Totals:I"''- ""['"- "'""""1""""""— Detection/Alerling Devices
No.of Dishwashers Space/Area Heating KW Local unicipal ❑ outer
Connection
No.of Dryers • Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters KW No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs Neibf Motors Total HP -Telecommunications Wiring:
No.of Devices or Equivalent
OTHER: •
Attach additional detail(/'desired,or as required by the Inspector of Wires.
Estimated Value of I trical Work: as,77-5 0d (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE RAGE: 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 certO,under the pains and penalties ofpedury,that the information on this application is true and complete:
FIRM NAME: Ra ck.a"1-EC7 I'L 2>4773-Corr) Z/V e. L•IC.NO.: '714 ea/$/
Licensee: /in:0 /0/e0 eic Signature
of aopplicable, ter"exempt'•to the license number Iln ) � LIC.NO.:aigy�,�
Address: `7?l�"exempt_
L�i)t) ST Bus.Tel.No. 0&' - --- !�/
*Per M.G.L.c. 147,s:57-61,securitywork fc dV 1 /),t"d g. MA-Oa 7 Ye) 1a ,5-9
reiuires Department of Public Safety"S"License: Alt.Lic, o. 'No.: - 00_3/
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
Owner/Agent requirement. I am the(check one)LI owner 0 owner's agent.
Signature Telephone No. 'PERMIT FEE:$ /DO,0 6 j