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HomeMy WebLinkAboutBLDE-22-006691 ........ er A Commonwealth of Official Use Only LA Permit No. BLDE-22-006691 f� 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:5/19/2022 City or Town of: YARMOUTH To the Inspector of Wires: 3y this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 11 NAUHAUGHT RD Owner or Tenant FURRER LAWRENCE E Telephone No. Owner's Address FURRER SHEILA A, 11 NAUHAUGHT RD, SOUTH YARMOUTH, MA 02664-4409 Is this permit in conjunction with a building permit? Yes ❑ No 0 *s 0/ / Purpose of Building Utility Authorizatioe-frie th 1 v 7 2 v' Existing Service 200 Amps Volts Overhead CI Undgrd ' New Service 200 Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Av In No.of Emergency Lighting No.of Luminaires Swimming Pool grnbod.e ❑ grn-d. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices Local ❑ Municipal 0 Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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: THOMAS J MADDEN LIC.NO.: 14065 Licensee: Thomas J Madden Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:39 MARINERS LN,PO BOX 291,YARMOUTHPORT MA 026750291 *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 my signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. (PERMIT FEE: $50.00I Ceci 6/2‘421Z- O ,' ll 0 . ' RECEIVED \A MAY 18102 y�j o nt♦sa ol///addachudafld �I r}4 L-t(`� B Ali DING DEPART NT c-� Permit No. -- r t[d s�ar�`am,. o/,}me�srvicsd �+ a;1 l q -' Occupancy and Fee Checked 4 ,,, 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(M 527 MR 12.00 I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5 j ) a/e?City or Town of: YARMOUTH To the Inspe for of ires: By this application the undersigned give no ice of r heriraion to orm electrical work described below. Location(Street&Number) // /1/ (� �- t -50 ,,- b �'-k.t Owner or Tenant �I el7q fL,Q,,� y`e f �U .e Telephone No. /-50 6-- 7 3 7— a--q Owner's Address ,.jQ,17 e R 3 a Is this permit in conjunction with a buildin permit? Yes ❑ No Er--(Check Appropriate Box) Purpose of Building J e W� Utility Authorization No. !Oc t /7 ,7 Existing Service01c0 Amps /pi° /,`�L/O'Volts Overhead®/Undgrd❑ No.of Meters � k/ New Service 200 Amps/)C' /O?'fD Volts Overhead©F Undgrd ❑ No.of Meters Number of Feeders and Ampacity a — 0./Cif 7,4/-J2 � 1 N Location andNature of Proposed Electrical W rk: l p�4 G._v( t'S.l/� Io#4�l ji ec —�- 1%r e2-GcQ pa p Y✓t,P l e ��=fX t)III A yCompletion of the followinktable maybe waived by the Inspector of Wires. ‘3,1 No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total ev Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 4t No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grrnd. 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 11 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 0 Co Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:1 No.of Devices or Equivalent No.of Water No.of 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 old OTHER: ,P A iv, (> Attach additionaldetail if desired,or as required by the Inspector of Wires. Estimated Value of lee ical Work: p (When required by municipal policy.) Work to Start: /3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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 covers s 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 pa ns a Renalties of p frJjtry,that he information on this application is true and complete. FIRM NAME: ,� LIC.NO.: j Q_5"-- Licensee:V rn Signatur LIC.NO.: (If applicable rater" xempt"• the li erase umber line.) fj /„ Bus.TeL No.• / Address: 06r a wl ,C) �(.T // Alt.Tel.No. f *Per M.G. .c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal) required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$