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HomeMy WebLinkAboutBLDE-21-006348 Commonwealth of Official Use Only Permit No. BLDE-21-006348 Massachusetts 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:5/4/2021 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) 56 CLEAR BROOK RD Owner or Tenant Ashley Saaden Telephone No. Owner's Address 56 CLEARBROOK RD,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Approp 'a 4 fi3 Purpose of Building Utility Authorization No. 54681 e Existing Service Amps Volts Overhead 0 Undgrd 0 No. " ei► New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of ��s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service V Completion of the following table may be waived ires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of s O Transformers 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/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 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:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Lloyd R Smith Licensee: Lloyd R Smith Signature LIC.NO.: 15688 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 1ST ST, MELROSE MA 021764010 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: $50.00 _— _ Commonwealth o/Maaeachuoetta Official Use O y . . * j= c�77 Permit No. (�Z( ' LL 3 1epatment ole Servdceb1(S -__0-- ` Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC 5 7 CMR 12. (PLEASE PRINT IN INK OR E ALL I��FOR� ON) Date: m I City or Town of: IYl 0�v I \ To the Inspector o Wires: By this application the undersigned Ilk notice ff his, or her lute tion to perform the electrical work described below. Location(Street&Number) (CD GO n / . Owner or Tenant ir\ Telephone No. Owner's Address V v l 1 /� Is this permit in conjunctiojwith a building permit? Yes ❑ N®� (Check Ap rop 'ate Box) Purpose of Building .} -1 f Utility Authorization No. 1 y q Existing Service ICE Amps 133 / I40 Vv o s Overhead Undgrd 1 g ❑ No.of Meters New Service Amps / Volts Overhead Undgrd I I No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 0 a0 is p SeA V l J Completion of the following table may be waived by the Inspector , ' zres. 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 grad. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Rio.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: i ) Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent No.of Heaters KW Data Wiring: 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 iif desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start 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 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The unless undersigned certifies that such cov�e' ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE l+� BOND ❑ OTHER 0 (Specify:) I certify, under th pains and pen�^a�lt�ige,s, of per' ry,that the information on this ap 'cation is true and complete. FIRM NAME: i 1 1 f-' �Zil,V ` . L(.� / j� !"" LIC.NO.: Licensee: L, er -x� a Signature �.y (If.applicable.enter "exempt"in the license number line) LIC.NO.: O 3 5 Address: T ; �,i1 " SVA 4 l,�r-\ Q 1 °-ra.( rp, , Bus.Tel. No.: *Per M.G.L. c.`147,s. 57-61,security work requires Department of Public Safety"S"License: Alt.Lic. 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:$ 1