Loading...
HomeMy WebLinkAboutBLDE-23-001084 or o 'U Commonwealth of Official Use Only filLI t I, 4) Massachusetts Permit No. BLDE-23-001084 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:8/30/2022 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) 10 CLIFFORD ST Owner or Tenant O'PACKI PETER F JR Telephone No. Owner's Address O'PACKI PATRICIA, 50 BELLVISTA RD,WORCESTER, MA 01682 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: Wiring for two(2)mini-split systems 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 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. 2 Ton l No.of Alerting Devices 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 ❑ Connection Municipal 0 Other: 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 perjury,that the information on this application is true and complete. FIRM NAME: Michael J Chase Licensee: Michael J Chase Signature LIC.NO.: 20654 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 19 MAYFAIR RD, SOUTH DENNIS MA 026602903 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:$50.00 CornaloawfaIlL 4 Maeoneha did Official Use Only I. it !r / n Permit No. _ 3— �o 0 ati spa ..,0 Jsrvtcsd f 1/41/4, Occupancy and Fee Checked f BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( },52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: FR D..Q ' _TX__ City or Town of: yt{�(Z4,4, To the Inspector o Wires: It 4 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) TO 6 F-eeo � -Cpe..e ie „S V�'1244.7o lay ri q Owner or Tenant e 0 e AGf j Telephone No.,sZls'-31 y 37 a 4 Owner's Address f© GC r/0a - /i .5.. `7*2—i'11 Is this permit in conjunction witli a l!uilling permit? Yes 0 No g_. (Check Appropriate Box) , t Purpose of Building el-,57 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters • Number of Feeders and Ampacity Location and Nature of Pr oposed Electrical Work: W Cam.(i. ftl�M i`N t si,d r"T"lJ1J-ts , NI vt Completion of the followingtable my be waived by the! for of Wires. Total No.of Recessed Luminaires No.of CelL-Susp.(Paddle)Fans Tan€ Tr KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- ❑ No.of Emergency Lighting grad. mod. Battery Units •,1 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 To i 1-1No.of Ranges No.of Air Cond. Toga No.of Alerting Devices No.of Waste Disposers Number Totals: :Tons _KW m—No.of DetectSelf-Contained No.of Dishwashers Space/Area Heating KW Local❑ M� 0 Other SecuCyonnection No.of Dryers Heating Appliances KWNa of Devices or Equivalent No.of Water No.of No.of Wiring: Heaters KW Da Signs Ballasts No. Devices or 4 aivalent No.Hydromassage Bathtubs No.of Motors Total HP Tekcomm Device oas o • No.of Device cation or E9 nt OTHER: Attach additional detail if desine4 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. 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 a BOND 0 OTHER 0 (Specify:) I certifp,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: -E. G CT?14G !"p , 7NG • LIC.NO.: I S) I Licensee: /V/( i r✓L GC/.cE Signatn LIC.NO.:a.66 11 it (lf applicable, in the license number Bus.Tel No.• - — l t Address: /� ere n 111 e ... . l ivP7 j,�.` d-v�G 1��y Alt.TeL No.• d *Per M.G.L.c. 147,s.57-61,security work requires r . 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. Owner/Agent Signature Telephone No. PERMIT FEE:$