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HomeMy WebLinkAboutBLDE-21-000947 Commonwealth of Massachusetts Official Use OnlyO 1itip_m_ r Permit No,0L "{ YR 7 Lt Department of Fire Services fi=� BOARD OF FIRE PREVENTION REGULATIONS Occupancyv90 and Fee Checked ''�,� [Rev.9/OS] (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 TY,PE ALL INFORMATION) Date: V4120 City or Town of: vLtrrvla✓kl To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 3,Location(Street&Number) a brtJ nW M 44', �'4-, Sou Yt//ociorn 026 C y Owner or Tenant 1 ,l{uV 0 0 o la/P. Telephone No. 50<6 31 g ''zG Owner's Address 5(A t1 Q Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building (olo tf GI tit 1 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ N .of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: R r I'l"l 5 114 l l I 1 a n Aeleule e—ozrm L, ,z-r f(e'3 Completion of the following table may be waived by the Inspector of Wires. o. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf T Trt•anansformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.ofEmergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grid. ❑ 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 Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 'KW No.of Self-Contained i Totals: . Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal Connection ❑Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No,of No.of No.of Devices or Equivalent Heaters KW 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 requested in accordance with MEC Rule 10,and upon completion. V INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical Work may issue unless `7--• -- the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The S undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. S CHECK ONE: INSURANCE ® BOND ❑ OTHER (Specify:) ❑ ( p fY) f� I certify,under tl:e pains and penalties of perjury,that the information on this ap lication is true and complete. FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO., IV LIC.NO.:3281 C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 1, \ Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 E-MAIL:INSPECTIONS@EFWINSLOW.COM Alt.Tel.No.: P *Security System Contractor License required for this work;if applicable,enter the license number here: 7ta „ p OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally r� required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner n owner's agent. VE, Owner/Agent Signature Telephone No. PERMIT FL'E: $