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Home My WebLink AboutBLDE-22-006055 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-006055 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:4/21/2022 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) 17A NEARMEADOWS RD Owner or Tenant Siominski Sarang Telephone No. Owner's Address 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 ❑ 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: First floor bathroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 2 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 rnd. rnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total 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 0 Municipal ❑ 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 Signs 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: LONGFELLOW DESIGN BUILD Licensee: Jeromme Marques Signature LIC.NO.: 22751 (If applicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address:26 Lake Avenue,Woburn MA 01801 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: $75.00 6--(q( kgpr- 8(231 ZV (4': 40 (110 cL I I tri,/ . ._-- - r^ ,_ � ` cEIVED APR 20 2022`It Commonwealth al///aadachudette Official Use Only BUILDING DEP I�� - �+� cc�/ n Permit No. �(J 57 _ :. apartment of ire Serviced — '(� BOARD OFOccupancy and Fee Checked 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 MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ( 2 /a� /Z a Z_ City or Town of: YARMOUTH To the I pector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) I )/(J En-FM e j 4.-C/0 S Owner or Tenant 3/ P4/A -)-/C i s /241,1-c, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑" No 0 (Check Appropriate Box) Purpose of Building 5/ /i^'f.l t r 4 Utility Authorization No. Existing Service 2p t9 Amps )Lc7 /Z21,syolts Overhead ❑ Undgrd 0 No.of Meters fr New Service Amps / Volts Overhead❑ Undgrd g 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /S f FAO 0, 1 �L/ ,� r7 vl f,yru Completion of thefollowinntable maybe waived by the In vector of Wires. No.of Recessed Luminaires No.of Total rsVi No.of Ceil.-Susp.(Paddle)Fans Transformers KVA '=:� No.of Luminaire Outlets No.of Hot Tubs Generators KVA �� t No.of Luminaires / Swimming Pool Above ❑ In- 'No.of Emergency Lighting gird. grnd. ❑ Battery Units a No.of Receptacle Outlets ( No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners s. _ 'No.of Detection and 11Ranges` No.of Total Initiating Devices No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number„i Tons J KW No.of elf-Contained Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municip Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: c f 7 a • " (When required by municipal policy.) Work to Start:9'T,p/c? '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 w the licensee provides proof of liability insurance includingcoverageal ak may luivalnt.ent. unless undersigned certifies that such coverage is in force,and has'exhibited proof of same to the permit issuing ofCe The CHECK ONE: INSURANCE ❑ BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on t • application is true and complete. FIRM NAME:�C-1 j LicenseeA E: ,� fE/�p*c� `/Zf/� `� LIC.NO.:. Si store LIC.NO.: /`t In (!f applicable,er�ter`"exempt' n the license number line.) '� Address: 2_(aa if) ,e;`� 1Lhe Girob cil ,— Al ,Qj y c,/ Bus.Tel.No,: �_ *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.LiTel 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 ■ owner M owner's a,ent. Owner/Agent Signature Telephone No. PERMIT FEE:$ 7 -