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HomeMy WebLinkAboutBLDE-22-003343 Official Use Only Commonwealth of An I f. _ Massachusetts Permit No. BLDE-22-003343 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:12/13/2021 To the Inspector of Wires: City or Town of: YARMOUTH By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 61 SUFFOLK AVE Telephone No. Owner or Tenant SPLAINE JUDITH A Owner's Address SPLAINE JAMES R, 3 REDGATE DRIVE, MEDWAY, MA 02053 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: Receptacle for fire place blower. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Cei1.Susp.(Paddle)Fans No.Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ ofIn- Emergency Lighting grnd. grnd. ❑ N Noo.. v Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS INo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Ton Heat Pump I Number I Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices 0 Munici al No.of Dishwashers Space/Area Heating KW LocalConnection 0 Other: Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or Equivalent NoNo.of No.of Ballasts Data Wiring: He Water KW Signs No.of Devices or Equivalent Heaters Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Eauivalent 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: A J PULLEY LIC.NO.: 21843 Licensee: A J Pulley Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:289 QUAKER MEETING HOUSE,RD,E SANDWICH MA 025371366 *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 'PERMIT FEE: $50.00 Signature Telephone No. DIC°1 �j Commonwealth of//laaeacLotte Official Use Only �. � - S Permit No. � _ �_ 2apartmen of ira oruce6 _ _ v Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. `�,,t+�� TIONS 1/07] (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: o4,,4►2:ww v t to 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) 6 I SU Fr0LLL ,A-1/i� M (n Owner or Tenant Telephone No. v�t 5,P L/�,,J i- lj Owner's Address 1` Is this permit in conjunction with a building permit? Yes ❑ No ©' (Check Appropriate Box) Purpose of Building i2F5,ix,,,--r,A i 11.tnJe2",jt, Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity q Location and Nature of Proposed Electrical Work: 1,,,s T9-.L i?t-r t"r.rt�.c „„ ;;",hr, i r ✓ ►ire t,hS 1,►vcE12 c I Ar-cf> tr- A-.7r3 7 t A M ,y Completion of the following table may be waived by the Inspector of Wires. No.of Total it No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA ki No.of Luminaire Outlets No.of Hot Tubs Generators KVA n Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets ni No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal Other No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ v Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent W Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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: t /3 /2 t Inspections 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 covers a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 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: i 4,,,„ n,L i ,R1r.1.\ I=m e t a tc LIC.NO.: Licensee: )?tk Signature LIC.NO.:,-2i 121,7 (If applicable, Bus.Tel.No.: V.V..rfe a hcable,enter"exempt"in th`license number line.) Alt.Tel.No.• Address: �9 i?n,1 /LI0 t Sie.: -W DcAkvis rvA e7LG7 *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)0 owner 0 owner's agent.I Owner/Agent Telephone No. I PERMIT FEE: $ Signature