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Home My WebLink AboutBLDE-22-005256 aAV Commonwealth of official Use only I !I Massachusetts Permit No. BLDE-22-005256 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:3/21/2022 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) 959 WEST YARMOUTH RD Owner or Tenant LLOY ANNA M TRS Telephone No. Owner's Address ANNA M LLOY TRUST, 959 WEST YARMOUTH RD,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: 2 bed , laundry,&bath remodel Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 7 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 In CI Battery of Emergency Lighting grnd.Above ❑ grnd.- Battery Units No.of Receptacle Outlets 20 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 7 No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained 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 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Simon Baba Signature LI NO.: 22714 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:29 Captain Lumbert Lane, Centerville Ma 02632 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 7749949255 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)) El owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $75.00 I Q.,0C47( 17)1-'1'272-1(e- c R CJ IVE D D (�fCQ�( MAR 18 2022 BUILDING D °y— �,. ~� ENT Commonwaalj o`rlaeeacltwella i Official Use Only .[JeParlmnt o''�1,,,srurese Permit No. `� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked APPLICATION FOR PERMIT TO PERFORMRev. lm�� leave blank �— All work to be performed in accordance with the Massachusetts Electrical LECTRICAL00 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATTON) City or Town of: R A Date: 3 LL Z y this application the undersigned 'vY e' !O U�H roUon to To the Inspector of Wires: Location(Street&Number) ggse} perform the electrical work described below. Owner or Tenant Pai f f� 1 Owner's Address 9 e Telephone No. Is this permit in conjunction with a b r �Drpose of Building wilding permit? Yes No ❑ (Check Appropriate Box) !I siding Service A Utility Authorization No. Amps Volta Overhead 0 Und rd g ❑ No.of Meters VoltsyszAtnio Number of Feeders and Anspadty Overhead❑ Und rd❑ No.of Meters g _ Location and Nature of Proposed Electrical Work: oor 2, a imr./ ti rem • lia No.of Recessed LuminairesCom,lelfon, the opowi ; fable m be waived b the/ for o Wires. n ,.7 No.of Cell.-Soap,(Paddle)Fans T o.o No.of Luminaire Outlets Transformers A No.of Hot Tubs si` No.of Luminaires swimming i.F o.of swimming Pool ',de ❑ n- o.o 'mer ea KVAg Receptacle Outlets °d• ❑ Batte Uaitgs g n No.of Oil Burners IZZEZMIINo.of Switches No.of Zones 1111 No.of Gas Burners No.of Ranges ,e'o r^eC ,DAD No.of Air Cond. o If Alerting n Devices o.of Waste Disposers 'eat 'am Tons No.of Alerting Devices o.of Dish Totals: ._.um, r ons._. " " `o.o ' on.. n , Dishwashers Detection/Alertin Devices Space/Area Heating KW Local 'un i� , No.of Dryers ❑ Connection ❑ Other o.o a r Heating Appliances , • tT y ms: Heater KW `o.o Ballasts No.of Devices or ,uivalent No.Hydro S ,sData No. iring: o fDe ° Be Batht°M No.of Motors of Devices or ',nir alert OTHER: Total HP a ecommun a ona } g No.of Devices or • .trivalent Estimated Value of Electrical Work: Attach additional detail"desired,or as required the Ins to Start Z _. (When required by municipal Policy.) 9 by hector of Wires. WorkSURANCE COVERAGE: Inspections to be requested in accordance with Unless waived by the owner,no permit for the MEC Ruleo eland upon completion.issuea the;licensee provides proof of liability insurance including"cooperation" ►ue,licensee provides certifies that h liability ge is in force, "completed !coverage or ts�stantial a may nt. unless I c1 CHECK ONE: INSURANCE BOND 0 OTHER exhibited proof of same to the permit issuing office. The fY,under the pains and pens ofpfperjury,that the information 0 on this application is true • FIRM NAME: St w►pyt 60) and eonrplete Licensee: �*hi vt t LIC.NO.; z(llpPplkabte enter ex to the liters Suture y Address; ,� "� ►lbre.) LIC.NO.: *Per M.G.L.c. 147,s. 7-61,security work requires Department C�efVj� /i,4rju Bus.TeL No.• �/ 5 ---------- OWNER'S INSURANCE WAIVER; 1 am aware �Pnent of Public SafetyAle.TeL No.: O94ired by law. Bythat the Licensee d "s"License: Lic.No. my signature below,I hereby waive this ° not have the liabilityinsurance coverage normale Signature Owner/Agent requirement. 1 am the(check one ■ owner owner's s a;ent. Telephone No. PERMIT FEE:$ 7LS--—