Loading...
HomeMy WebLinkAboutBLDE-22-000031 Commonwealth of Official Use Only 0.1111):' Massachusetts Permit No. BLDE-22-000031 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:7/2/2021 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 described below. Location(Street&Number) 22 CAPT STANLEY RD 60e-3 - Owner or Tenant Greg Hudson Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check 4 Approuix) Purpose of Building Utility Authorization No. O+Ec.," JJ 9 Existing Service Amps Volts Overhead 0 Undgrd 0 i�t5~ et New Service Amps Volts Overhead 0 Undgrd 0 , : s Number of Feeders and Ampacity © , Location and Nature of Proposed Electrical Work: Remodel basement area. C. 0 8e4Pct Completion of the following table may be waive, . 1 e res. No.of Recessed Luminaires 22 No.of Ceil:Susp.(Paddle)Fans No.of , Transformers No.of Luminaire Outlets No.of Hot Tubs Generators No.of Luminaires Swimming Pool Above 0 In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers 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 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 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 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 I F krr RE;CEIV JULT2 / /021 e22-003( 111,10r021 Co nwoa �� Otf„al r►., __ l' B / Y— Permit No. BUILDING t7EPARTM; ,u 2spartmsnf o in ervu 11 BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked '` [Rev. 1/07] (leave blank) , APPLICATION FOR PERMIT TO PERFO RM ORM ELECTRICAL WORK Q....) All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (i /Z 2 / City or Town of: YARMOUTH To the Inspector f Wires: By this application the undersigned gives notice of his or her intention to perform the el trical work described below. Location(Street&Number) Z� (� '�,� (�(� Owner or Tenant 7 ua,5cn ' Telephone No. , —3/ ( 0 ' l Owner's Address 2 d e - y c4,,�v F�/ N Is this permit in conjunction wi a building permit? /Yes �No El (Check Appropriate Box) Purpose of Building E r'A,fr,,--Lerp Utility nthorization No. Existing Service ZCC Amps / Volts Overhead Undgrd El No.of Meters New Servic o -fps -- -o vaas Overhead❑ Undgrd❑ No.of Meters • Number of Feeders and Ampaclty Location and Nature of Proposed Electrical Work: ?ill,- 1,., S•er462' a, . vi Completion of the followinktable may be waived by the Inspector of Wires. " No.of Recessed Luminaires ' No.of Cell.-Sasp.(Paddle)Fans No.of Total Z Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool Above ❑ In- No.of Emergency Lighting grnd. t rnd. ❑ Battery Units ":,•-! 4.No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones {A No.of Switches 3 No.of Gas Burners No.of Detection and 11. Initiating Devices 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 Municipal ❑ Connection ❑ Other No.of Dryers Heating Appliances )fit Security Systems:*No.of No.of Water KW Heaters Signs Ballasts No.of No.of Data W�Devices or Equivalent Na of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP . Telecommunications Wiring: ' No,of Devices or Equivalent OTHER: IIAttach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: tP (When required by municipal policy.) Work to Start: ISA 7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VERAGE: 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 the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: Address: Bus.Tel.No.• Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: AIL Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insu ce coverage normally required by law. By mysignature below ereby waive this requirement. I am the(check one) wner owner's a ent. Owner/Agent .--' / Signature / .,.., --., p , 92 1 PERMIT FEE:$ J � �'�� Telephone No.5