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HomeMy WebLinkAboutBLDE-21-004583 �It° Commonwealth of Official Use Only ':.._1 Massachusetts Permit No. BLDE-21-004583 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'2/12/2021 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 CHARLES ST Sb Cp ..3 1 - 7 LI 0 9 Owner or Tenant THIELMAN WILLIAM J III Telephone No. Owner's Address THIELMAN EVELYN M, 29 CHARLES ST, 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: Build bedroom&bath over garage. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 6 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 g bovend ❑ grnd ❑ No.of Emergency Lighting r . Battery Units No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALARMS No.of Zones 2 No.of Switches 12 No.of Gas Burners No.of Detection and 6 Initiating Devices No.of Ranges No.of Air Cond. 1 Total 1.5 No.of Alerting Devices 1 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* 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: 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: Licensee: Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: Address: 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 does not have the liability insurance coverage normally required by law.But signature below,I hereby waive this requirement.I am the(check one)) ❑ owner ❑ owner's agent.Owner/Agent Signature Telephone No. 'PERMIT FEE: $75.00 I ' 16 �r 13LD .2f — o °Ls46O Commonwealth of t'/JassacluLdef ,. Official Use Only imp_ .2 ooarfine,t al. e Serviced Permit No. ' `7 D BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked i • v. 1/07] eave 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 INFORMITION) Date: 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) a C i//!Q LE(Ai .j T. rnrn f(- Owner or Tenant 6 A E D nn S© • I�l ��T t 1 p f I) Th !-eIm4n Telephone No. Q $-1 Owner's Address $ f ! m E Is this permit in conjunction with a building permit? Yes s VC No 0 (Check Appropriate Box)Purpose of Building R r Utility Authorization No. Existing Service3A0 Amps �. I Volts Overhead ❑ Und d �' K No.of Meters New Service Amps I Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f,t/ Llk_ cr mo,p &.. - P�� � Y r J � Completion of the following Ay may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-S addle Fans -----r No.of �^ Total �•� ) Transformers KVA "--No.of Lumiaaire Outlets No.of Hot Tubs `--- - Generators KVA No.of Luminaires ri Swimming Pool Above ❑ In_ No.of ll mergency Lighting - =� Qrnd. 0Bary Units �'^ No.of Receptacle Outlets 1 D., No.of Oil Burners FIRE ALARMS trio.of Zones a No.of Switches p-, No.of Gas Burners ----' No.of Detection and Initiatinz Devices No.of Ranges ' No..of Air Cond. Total i Tons No.of Alerting Devices I No.of Waste Disposers -- Heat Pump Numb Tons K No.of Self-Contained Totals:I { Detectio. Alerting Devices ----"'No.of Dishwashers ' —" Space/Area Heating KW Local IF v unicipal Connection ❑ Other No.of Dryers Heating Appliances , Security Systems:* No.of Water No.ofNo.of Devices or Equivalent - KW No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent-No.Hydrornassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent''"7 Estimated Value of Electrical Work Attach additional detail t desir_ f ed or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: o��j�lnspe lJ ctions 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 ❑ OTHER x (Specify:) I-IOn E O te-'4 E k I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: r� ""�._ LIC.NO.: r Licensee: A g' Signature /(� LIC.NO.: (If applicable,en er"exemlicense numbe line.) - . Address: 1 CH A iNteil S f S-d A In a _/v� /. Att.Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires D rt afnent of Public Safety e Lic. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance overrnally age no 5 required by law. By my signature el ow f reby waive this requirement. I am the(check one iI owner Elowner's a_ent. k Owner/Agent ,(, nl� �C>1 Signature 4..y ` Telephone No. PERMIT FEE: $ 60