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HomeMy WebLinkAboutBLDE-22-005511 0 y-) Commonwealth of Official Use Only Permit No. BLDE-22-005511 Itil 1M 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:3/31/2022 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) 61 OUT OF BOUNDS DR Owner or Tenant Amy Leepartuka Telephone No. Owner's Address 61 OUT OF BOUNDS DR, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes ❑ 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel basement&add sub panel. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 40 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. gird. Battery Units No.of Receptacle Outlets 50 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 25 No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. 1 Total 2.5 No.of Alerting Devices Ti No.of Waste Disposers Heat PumpNumber , Tons KW No.of Self-Contained 2 p Totals: . Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers 1 Heating Appliances KW Security Systems:* ry No.of Devices or Equivalent No.of Water 1 KW No.of No.of Ballasts Data Wiring: 2 Heaters Siens 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. required bymunicipal policy.) Estimated Value of Electrical Work: (Whenq p p y' 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: Signature LIC.NO.: 57427 Si Licensee: Timothy Robery g Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: 5083640419 Address: 1 Carol Road,Buzzards Bay MA 02532 *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) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $75.00 I T21560464— 12" VS/ice ...1,04/. V 1 (V7/ e-Z 4 - � - RECEIVED t( � 0L c��L MAR 3 0 �. ,j maaeac/.0 4ie Official usC�rty -. ,I Permit No. �`� "« its. -- -- ---1 el.tirs se,,,kes 1'` I BUILDING ULNA Occupancy and Fee Checked �i ° B' ' -- -'-`-"- ENTION REGULATIONS (Rev. 1/07] (leave blank) c. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE LL INFORMATION) Date: 3O Cn City or Town of: �j'j� rJj To the Insp ctor Wires: J By this application the undersign ives notice of his or her intention to perform the electrical work described below. I A Location(Street&Number) r//9 �T- /11JfV Owner or Tenant',if Lr � �� Telephone No.o9e - �f \ Owner's Address „1©l` idf � j�/lS s �f� 5 % Q�J��- 3 7 k Is this permit in conjuncts n with a building permit? Yes ❑ No ir (Check Appropriate Box) iPurpose of Building /j iQ5 t/tolt,/ - "I:i v./A j e Utility Authorization ... Existing Service idQ Amps / Volts Overhead 0 Undgrd No.of Meters I \... , New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters ----N Q‘. Number of Feeders and Ampacity j Location and Nature of Proposed Electrical Work: j A c'eriwe yt/r'— U e os_" 1-7_, im.xjzcz__.. ./9- I�LEI) /N /iirattem/- Completion of the followingtable mg be waived by the Inspector of Wires. No.of Recessed Luminaires V No.of Ceil.-Susp. Fans No.oof 0 KVAotal (� p (Paddle) � Transformers ? No.of Luminaire Outlets No.of Hot Tubs d C. Generators ( KVA ) ' Above In- No.ot"Emergency Lighting 0 No.of Luminaires Swimming Pool arnd. ® and. ❑ Battery Units No.of Receptacle Outlets 0 No.of Oil Burners e7 FIRE ALARMS No.of Zones 0 No.of Switches is-- No.of Gas Burners 0No.oThetection and Initiating Devices No.of Ranges 0 No.of Air Cond. / Tund i No.of Alerting Devices rL Heat Pump Num-ber-'Tons KW No.of Self-tontained No.of Waste Disposers (9 Totals: Detection/Alerting Devices Municipal No.of Dishwashers a Space/Area Heating KW ) Local❑ Connection ❑ No.of Dryers Heating Appliances stems:I KW� � iNro.tofSDevices or Equivalent a No.of Water KW No.of �} No.of Data Wiring: Heaters / _ Signs �/ Ballasts 0 No.of Devices or Equivalent g No.Hydromassage Bathtubs 0 No.of Motors & Total HP V 'TelecommunicationsNof Wiring: No.of Devices or uivalent OTHER: 0 -7dAj t'N' /- bl / I- _"-U.J A Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electric 1 Work: Jf MO,Ot i(When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: Unless waive• by the owner,no permit for the performance of electrical work may issue unless the Iicensee provides proof of liability i -. : ce including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coy ..le is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE t BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of pp rimy,that the Information on this application Ls true and complete. FIRM NAME: �/U/B?1�1 //(,/J112f LIC.NO.: Licensee: c?1//q ..- / Signature ` LIC.NO.: (If applicatle,enter"exempt"in the license Aumber line.) Bus.Tel.No.. SOS-.?f 1 6Jcal Address: / G 40, [3 g.2 g/t 0, / / /49 Q/5, 1_ Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requires Departmefit of Public Safety"S"License: 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)❑owner ❑owner's agent. Owner/Agent PERMIT'FEE: S �S°n Signature Telephone No.