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HomeMy WebLinkAboutBLDE-21-005936 Official Use Only � Commonwealth of LikAll Massachusetts Permit No. BLDE-21-005936 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:4/14/2021 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) 12 SHAKER HOUSE RD Owner or Tenant MCCABE KATHLEEN E Telephone No. Owner's Address 19 DONNA RD, HOLLISTON, MA 01746 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 ❑ 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: Kitchen renovations&bathroom fan/light. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires 5 No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Abo ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grndve. grnd. Battery Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS I No.of Zones • No.of Detection and No.of Switches 5 No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number 1 Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices al 0 Municipal No.of Dishwashers 1 Space/Area Heating KW LocalConnection ❑ Other: Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of No.of Data Wiring: No. Water KW Signs Ballasts No.of Devices or Equivalent Heaters 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: 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: David G Leach LIC.NO.: 15886 Licensee: David G Leach Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address: PO BOX 770, CENTERVILLE MA 026320770 *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 owner liability❑s insurance coverage normally required by law.But s signature below,I hereby waive this requirement.I am the(check one) I Owner/Agent I PERMIT FEE: $75.00 Signature Telephone No. caq/14 *1q1Qta-C. L( 111 t.,oms.0nw 4Massachusetts Official Use Only ,. f, Permit No. 2l—`S°I-- w ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] heave 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: i - i2 - ,--/ City or Town of: f-rr /YL o i' To the Inspector of Wires: By this application the undersign 1 gives notice of his or her intention to perform the electrical work described below. 0,21s 7S Location(Street&Number) /4t 4/-I*K #d ' R 7 J yA-IZAI 0 trrje`"�2� 01�i Owner or Tenant Y�/a-Thi- A2c C. l� Telephone'rio.5O3• 2S 7144 - 4.157 owner's Address J 4 7 e•ALIA 1g 7. O A1-Z v 10.V. /ii/ e b i 74 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate lion) Purpose of Building f 0 t Pr P Air- - Utility Authorization No. Existing Service/P D Amps f o /g Volts Overhead ErUndgrd 0 No.of Meters New Service Amps / VoltsOverhead 0 Undgrd 0 No.of Meters Number of Feedersand Ampacity I tom/ //'a RI�`p Location and Nature of Proposed ork: _5 p.41 [CsA Y �-`y /A r i 4 1A•J 4--" V'rr i l'e . AD 0 AJ kr i GY t1 N(i 62 14 .e_ -r, Y( ki I /s-/ 1-t •A✓t, c, M 2 e ex,Muff/ Completion of the followMgtablc» ire waived by tWItifector of Wires. vl N o Na of Recessed Luminaires No.of Cell.-Snap (Peddle)Fans Tranasformers CA No.of Luminaire Oud� No.(Allot Tubs Generators KVA C No.of Luminaires Above - 1Va of Emergency Lighting Swimming Foot grad. ❑ graInd. � Battery Units No.of Receptacle Outlets 8', No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches j' No.of Gas Burners Na of lemming ooDevin ces n l No.of Ranges KY 5 No.of Air Cond. ns No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: -----"---------- No.of Dishwashers / Space/Area Heating KW Local❑ C necdee unicipid © Other Security Sy :* No.of Dryers neating Appliances KW Na of I1 or Equivalent No.of Water No.of Na.of Data Wiling' Heaters KW Signs Beasts No.of Devices or Equivalent HP Telecommunications .. No.Aydromiaasage Bathtubs No.of Motors TotalNo.of Devices ec Etta OTHER: Attach additional detail ifdestred or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: r/_ G •- r-I 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 cc.tve9tge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:),M i /At S I, i*Me/Q-Ge-i8- 1'q a-/ I certify,wider the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: �` LIC.NO.: 1 a- i E-4- ..t? Signatures .�J ., -Z-- LIC.NO.: /6- (S' l° Licensee:�>�� � - ,� (if applicable,enter,,exempt.,in the license number line.) Bus.Tel.No.:s0 3 'i-."° e Address: 7'a $a fr' ?7 a c eAS7TE-zLVr GLr .�14i. 1 A-L %�- Alt Tel.No.: *Per M.G.L.c. 147,s.57-61'security work requir6 Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑.owner's agent Owner/Agent I PERMIT FEET$ 7 v Signature Telephone No.