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Home My WebLink AboutBLDE-22-004440 . 6\/ ' Commonwealth of Official Use Only 19 / _ 0Massachusetts Permit No. BLDE-22-004440 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:2/9/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention erform the el al work described below. Location(Street&Number) 52 PRINCE RD V!v V L,If2&J Owner or Tenant RIEPPMDARilitARWr Telephone No. Owner's Address 52 PRINCE RD,WEST YARMOUTH, MA 02673 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: Low voltage A/V wiring. 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. grad. 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 No.of Alerting Devices Ton 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 ❑ 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 Ci1(17 r e EIVED FEB 0 9 2022 L`0 ` _ �oguxowursa[tkweear�iaelfa Official vsUe�,nl�i�yLI,�� YU L!' a� ' ad MENTc-i Permit No. -- t 1 C) c7� r tr r ., — .CJsparfineeE o�_tiro..3ervicfe c and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Revv. 10 j y (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK _� All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO lIONJ Date: Z 2Z City or Town of: \f c .ryv To the Inspec or o Wires: By this application the undersigned gikes notice of his or her intention orm the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No 77 • — r Owner's Address 73 7 Is this permit in conjunction with a building permit? Yes lit No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ 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: ( A t \0\ A ,11 i,)Art i rrl v Completion of the foliowin table my be waived the/ or of Wires, tb No.of Recessed Luminah es No.of Cell. Fans Snap.(Paddle) No.of �( Transformers KVA CI No.of Luminaire Outlets No.of Hot Tubs Generators ICVA No.of Luminaires S pool Above In- No.of Emergency Lighting il 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 Initiatng Devices Tot l ? No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW_.__ No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Munidpa nnecHan 0 Other _ Co No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Data Wiring: Heaters Sign Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicatons Wiring: No.of Devices or Equivalent OTHER: i ,. Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of El trical Work: / LIZ (When required by municipal policy.) Work to Start: 2.2_, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: 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 BOND 0 OTHER 0 (Specify:) I certify,under a pains and penalties o ury,that the information this application and complete. FIRM NAME: e' c LIC.NO.: cH,j Licensee: Signature LIC.NO (Ifapplicab , er"exem "in the license tuber line.) • o Bus.Tel.No.• 7 73� Address: Opp- eil4 v1 II r Al� Alt.TeL No.: *Per M.G.L.c. 147,s.5 -61,security work oftvarftent 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. w. By my signature below,I hereby waive this requitement. I am the(check one)0 owner ❑owner's agent. genSignature Telephone No. I PERMIT FEE:$ 5L)