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Home My WebLink AboutBLDE-22-006714 Commonwealth of Of Use Only kin Massachusetts Permit No. BLDE-22-006714 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:5/20/2022 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) 62 CLOVER RD Owner or Tenant Tatyana Zarharova Telephone No. Owner's Address 62 CLOVER RD,WEST YARMOUTH, MA 02664 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: Circuits for AHU per attached. 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 Initiating Devices No.of Ranges No.of Air Cond. T dotal No.of Alerting Devices on Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters ,Siens No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 ❑ BOND ❑ 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: loannis Palazis Signature LIC.NO.: 58242 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 176 West Street, Paxton MA 01012 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 -,.: RECEIVED MAY 19 2022 �'A onvnonwaa[th of///aeeachuadie Official Use Only ;� c'/ G DEPARTMENT " tii - ' ------N T cc77 Permit No.spartnunE o`.}i,Y Serviced Z' rf-5,i4 .. ,` BOARD OF FIRE PREVENTION REGULATIONS OccRev,upl/07]ancy and Fee Checked [ 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: S/y— 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. ation(Street&Number) Owner or Tenant'1I c -y 7 V h Gi Owner's Address Telephone No. ' Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building ,S QI 11.IL'Q\ (Check Appropriate Box) Utility nthorizatlon No. Existing Service S ( Amps p is 'IQvolts Overhead Undgrd 0 No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampadty 0 Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: —f '" 1 `/ ' / } A e.- /`�ct rn rC>V VI rf� Com leion o the ollowin table m be waived b the In ector o Wires. th" No.of Recessed Luminaires No.of Cell.-S°sp.(Paddle)Fans o•o ota No.of Luminalre Outlets Transformers KVA No.of Hot Tubs Generators KVA4' No.of Luminaires Swimming Pool rod.e ❑ °-d. ❑ o.o Units Emergency g ng No.of Receptacle Outlets Bette Units No.of Oil Burners FIRE ALARMS No.of Zones ::: No.ofRange No.of Switches No.of Gas Burners o.o etec on an s Initiatin Devices No.of Air Cond. o� Tons No.of Alerting Devices No.of Waste Disposers 'eat 'ump 'um,er ons ' " 'o.o e out ne Totals: .... .._...._............_._. No.of Dishwashers Detection/Alerth� Devices Space/Area Heating KW Local❑ un' pa on No.of Dryers Heating Appliances KWSecurity Cystems:* ❑ �� o.o a er o.o No.of Devices orEquivalent Heaters ' o•o Data Wiring: Si ns Ballasts No.of Devices or uivalent No.Hydromaasage Bathtubs No.of Motors Total HP e ecommun ca ons r gg OTHER: No.of Devices or E uivatlent (`�O Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Stttrt: *I �� (When 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 0 BOND 0 OTHER I certify,under the pains and Haiti 0 (Specify:) FIRM NAME: e(ary,that the inf r lion on this application is true and complete. Licensee: ;Q t �^ LIC.NO.r ya (If applicable.enter/"exe Signature • LIC.NO.: / nse vie n ¢e lie �num ' ' Address: vie J- J Bus.Tel.No.• �li 89 *Per M.G.L.c. 147,s.57-6 F '^ OWNER'S INSURANCE WAIVER: I�am aware sthathe Department does not havehe liability afety"S" � AiL Tel.No.: required by law. By my signature below,I hereby waive this requirement. I am the(check one ■ owner III insurance coverage normally Owner/Agent owner's a:ent. Signature Telephone No. PERMIT FEE:$