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HomeMy WebLinkAboutBLDE-21-005322 a z ,\� Commonwealth of Official Use Only (ti:,,,�ti'j_\, Massachusetts Permit No. BLDE-21-005322 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:3/16/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 156 WITCHWOOD RD Owner or Tenant SIMMONS CHARLES E JR Telephone No. Owner's Address SIMMONS ROBERTA J, 156 WITCHWOOD RD, SOUTH 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: Family room, bathroom, &panel 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. Total No.of Alerting Devices Tons 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts 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 ❑ 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: Robert J Sanborn Licensee: Robert J Sanborn Signature LIC.NO.: 793 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 16 SAXONY DR, MASHPEE MA 026492209 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 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 Ka (1-2/z,./ eg. (2kwett 94164 , ttx Com monweai h o`MR6444146404 Official Use Only z ''` * u `� apartment ce�7 Permit No. t=i� — ; J 7. M rUspartment of..ire Services ' _` Occupancy and Fee Checked BOARD OF 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: �1 a r ao?Oo2 l City or Town of: Yet- t 0 ,/ To the Inspector f Wires: By this application the undersigned gives notice of his or her inter'on perform the electrical work nbed be kw. Location(Street&Number) /5 �,u � W,t11 , o a 4 • s'p, yar-sin o✓v'—j/1/i' ()owe( Owner or Tenant CAark3 (cji7//ii 1fL...( Telephone No. 1 Owner's Address Is this permit in conjunction with a building permit? Yes Er"--- No 0 (Check Appropriate Box) Purpose of Building 1ps/c/eAl-C ,� re//,`t Utility Authorization No. Existing Service /d O Amps /020 l,%ZYd Volts Overhead 'LJ��y'Undrd 0 No.of Meters / g )Yew Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampadty 1 Location d Nature of P Electrical Work: ,`/ t7oo a-4 e,'x " ;,(// 6Shrod yn a. 0Vie/C/an e y / Completion of the followinVable m be waived by the Inspector of Wires. ay n�c otal ); No.of Recessed Luminaires No.of Ce 1.-Susp.(Paddle)Fans f TVA Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires g s� p� Above In- No.of Emergency Lighting g grad. ❑ Ern.. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and .g.. No.of Switches No.of Gas Burners Initiating Devices 1`:* No.of Ranges No.of Air Cond. TOEAlerting No.of Devices Tons No.of Waste Disposers Heat Pump Number,Tons_. KW... No.of Self-Contained Totals: Detection/Ale . Devices No.of Dishwashers Space/Area Heating KW Local❑ Co n w ;.nnectlnn ❑ Other No.of Dryers Heating Appliances KW Itecurity f y 1)evtees or Equivalent No.of Water ItR, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or uivalent No.Hydromassage Bathtubs No.of Motors Total HP Tekco of e o o r No.of Devices or Equiv nt OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work`!;? t(,i(),©(/ (When required by municipal policy.) Work to Start:3//73d o./ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO 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 cov a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I certfy,under the pains and penal. of pe►Iary,that!he information on this application is true and complete. FIRM NAME: /QO 6 e-1yAn d�K CCcl`rl�,—r LIC.NO.: Licensee: /0 6 p,-�}- 11..411 r v Signature £. Ati LIC.NO.: O.. 32117 lei (If aPPikab , Jar"exempt"i the 1!'�� a ber line. Bus.Tel.No.. Address:/6J CVO% f ol-fiv ye9 inn" 0 tf 7 Alt.Tel.No. *Per M.G.L.c. 147,s.S -61,security work requires Department of Public Safety"S"License: Lie.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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$