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Home My WebLink AboutBLDE-22-000166 po —_ Commonwealth of Official Use Only € 4441 iiiltk Massachusetts Permit No. BLDE-22-000166 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:7/12/2021 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) 257 STATION AVE Owner or Tenant MALAQUIAS CAROL TR Telephone No. Owner's Address THE 257 STATION AVE RLTY TRUST,29 ROCKY RIDGE, DENNIS, MA 02638 Is this permit in conjunction with a building permit? Yes ❑ 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: Install receptacle behind TV in doctors private office 'g .` Completion of the following 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 Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 perjuty,that the information on this application is true and complete. FIRM NAME: Joseph Rego Licensee: Joseph Rego Signature LIC.NO.: 14348 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 OLD MEADOW RD, BREWSTER MA 026312630 Alt.Tel.No.: *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 Signature Telephone No. PERMIT FEE: $80.00 6: )____ 2/ ( y' r I amino. omamm o/Masdachu t [Official Use Only � `� - Permit No. - [--- 0 l s+ epart'iment al.7ir�s Jervice:I ..P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1/073 (leave blank) _ APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK NAll 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: 6- 3 O-c 1 ., City or Town of: YARNIOUTH To the Inspector of Wires: \' . By this application the lmdetsigned gives notice of his or her intention to perform the electrical work described below. . Location(Street&Number) (95, 5A 7 Gn Ave Owner"or Tenant. for. 2.964 rra 40 5 Telephone No. Agoner's Address - 17 . -Ise this permit In conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) ,ih ' Purpose of Building be nii;( O ;(e Utility Authorization No. Existing Service Amps / Volts Overhead❑, Un No.of Meters ❑ New Service Amps / Volts Overhead❑ Undgrd El No.of Meters Number of Feeders and Ampacity • '-- Location and Nature of Proposed Electrical Work: _Z3441/ /?«r_ /e &#,) vi 7 V it) ')c OLD rS Priu44e t'7E 'er . _ -.._.. ._ Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell, e.of T tat gyp'(Paddle)Fans Transformers• ICVA p ofLunitaaiire Outlets No.Hof Hot Tubs Generators KVA • • of Luminaires Above In- No.of Emergency g Pool tad.. grad. Battery Units No.of Receptacle Outlets . ( No.of OE Burners FIRE ALARMS INC.of Zones No:of Switches No.of Gas BurnersNo.of Detect on and ' • Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump[Number'Tons f KW NNo ioNA Self-Contained f nntained Totals: No.of Dishwashers Space/Area Heating KW' Loaf ManIcipai ❑Connection ❑ ot117 No.of Dryers Heating Appliances KW Security S ms:* No.of Water No.of or Equivalent Heaters KW No.of No.of 'Data Wiring: Signs Ballasts No.of Dvices or Equivalent Ito.Hydromassage Bathtubs No.of Motors Total HP • Telecommunications Winng-. No.of Devices or Equivalent EITHER: - • Estimated Value of Electrical Work Attach additional detail yf'desh ed or os required by the Inspector of Wires. Work to start: (GVhen required by municipal policy.) 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE,f.5 BOND 0 OTHER 0 (Specify:) I certify,under the�tuns and penalties of erjury,that the information on this application is true and complete. FIRM NAME: \/,0S I./ ,v,� c/;,- LIC.NO.:_/y` ieensee: t Signature LIC.NO.: iftpllcabk ent t" `'in licersre number line.) Bus.Tel.No.�O�' G-d0// dress: ro y t r' }s•ier i'n 4)6 Alt.Tel.No.: j '"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 ❑owner's agent. Owner/Agent 4 Signature Telephone No. PERMIT FEE:$ �-a 1