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Home My WebLink AboutBLDE-22-000671 Commonwealth of Official Use Only ►��' Massachusetts Permit No. BLDE-22-000671 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:8/6/2021 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 describrel w. Location(Street&Number) 43 WEBSTER RD Owner or Tenant r' elephone No. Owner's Address PAa1nNc?f� IANA_10 �Qnr Is this permit in conjunction with a buildingpermit? — w P Yes 0 No 0 (Check`, • . Purpose of Building Utility Authorization No. �.. ,1 r Existing Service Amps Volts Overhead 0 Undgrd ❑ k i •e ers New Service � a Z 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New house Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 20 No.of Ceil:Susp.(Paddle)Fans 1 No.of Total Transformers KVA No.of Luminaire Outlets 10 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool gr bovend. ❑ nd CINo.of Emergency Lighting Battery Units No.of Receptacle Outlets 40 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 30 No.of Gas Burners No.of Detection and Initiative Devices No.of Ranges 1 No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices 6 No.of Waste Disposers No.of Dishwashers 1 Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.te of 1 KW No.of No.of Ballasts Data Wiring: 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 S eci I certify,under the pains andpenalties o (Specify:) f perjury,that the information on this application is true and complete. FIRM NAME: NATHANIEL TOMKIEWICZ Licensee: NATHANIEL TOMKIEWICZ Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 53813 Address: 104 THOMPSON ST, NEW BEDFORD MA 02740 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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. , �,r� (PERMIT FEE:$180.00 I C' , 8(C7� Ke 64 go l ( 1.11z.z. cam. (Pes,auE60--) \ evViCt i insLucetne rk, ..,e-E, 1 V E D - 6 AUG 0 w. Ca nmonwoa A/ �J ' ".- + "'`a°eacl'iu°°Ke Official Use Only _„�'`; v 2spart`numi o/ }' J Permit No, C��2Z- 7/BUILDING DE`- •r(',,4T irs srvrese By: — _�J`-- :OARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 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) City or Town of: ^ n n Date: u TiSi By this application the undersigned gives of 'of is or her Date: UTH electrical intention to perform the �desS a Location(Street&Number) described below. Owner or Tenant ,.7-at oP COwner's Address Telephone No. Is this permit in conjunction with a building permit? , Yes NO ❑ (Check Ap • propriate Box) Purpose of Building Existing Service Amps Utility Authorization No. New p ----/ Volts Overhead❑ Undgrd❑ No.of Meters rvice 20v Amps /Za/24)0'Volts---- Overhead Undgrd ❑ No.of Meters b 4 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�� lam//y•r .-, VI vo h Completion o the ollowin: table m, be waived b the In .ector o Wires. +,s No.of Recessed Luminaires 00 No.of Cell.-Sns . `o.o ''ti No.of Luminaire Outlets P (Paddle)Fans ota '� /6 No.of Hot Tubs Transformers KVA No.of Luminaires Generators KVA /G Swimming Pool rnd.ove ❑ n- 'o.o mergency g ng of Receptacle Outlets 0 No.of Oil Burners nd. Butte Units No.of Switches FIRE ALARMS No.of Zones • (% No.of Gas Burners `o.o etec on an i r No.of Ranges Initiatin Devices No.of Air Cond. ota No.of Waste Disposers 'eat 'um Tons No.of Alerting Devices P 'umier Totals: ............_...._._....... ligin o.o e - out• ne No.of Dishwashers / Space/Area Heating KW Detection/Aunret DevicesC. No.of Dryers Heating Appliances Local❑ Connection ❑ Other' 'o,o "a er KW ecu ty ystems: Heaters r„f j KW "o o .o ° No.of Devices or E uivalent Si ns Ballasts Data Wiring: No.of Devices or E t uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommun ca,ons " ring. OTHER: No.of Devices or E.uivalent Estimated Value of Electrical Work:/,� Attach additional detail if desired,or as required by the Inspector of Wires. Work to Stan: --=--__ (When required by municipal policy.) $-Z-L 1 Inspections to be requested in accordance with MEC Rule 10, INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may the licensee provides proof of liability insurance includingand upon completion. theun licensed es proof f h cov "completed operation"coverage or its substantial equivalent. The CHECK ONE: INSURANCE ge is in force,and has exhibited proof of same to the permit issuing office. I certify,under the pains and penalties BOND OTHER 0 (Specify:) FIRM NAME: •fp perjury,that the information on this application is true and complete. Licensee: ,• E (If applicable,enter"exem 6 �' �"'c Signature shLIC.NO.: ... J Address: / in the 'e e num er line ll�II LIC.NO.:VS___3 S)3 �� 7" ' Bus.Tel.No.:7,i *Per M.G.L.c. 147,s.57-61,security work requires De —7 ' `/Q INSURANCE WAIVER; Department of Public Safe Alt Tel.No.' OWNER'Srequired by 1IN gn 1 am aware that the Licensee does not have the liability insurance coverage n—' Owner/Agent By my signature below,I herebywaive this requirement. I am the(check one Signature I owner / owner's a:ent. Telephone No. PERMIT FEE:$ �-c slc21z i( ck4 q(9(zi 3I14S-p (Ctz) 8C4' _ uctwyP.