Loading...
HomeMy WebLinkAboutBLDE-22-005645 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-005645 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:4/4/2022 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) 161 MID-TECH DR 5PP 731- Q /23 Owner or Tenant Kerry Aylmer Telephone No. Owner's Address MA Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: service inspection meter was off over 1 year(UNIT F) 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 Initiatine Devices No.of Ranges No.of Air Cond. Total n No.of Alerting Devices 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: John J Throckmorton Licensee: John J Throckmorton Signature LIC.NO.: 11465 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:53 CORTE REAL AVE, E FALMOUTH MA 025365343 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 my 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: $80.00 11) — (kit `iiiii4.414 (CA& to,mieeptiteD47, 4(01v2, C 7 (A-tle: x OF r3Cs>G'• eawr le A16. ei(612/L G'1CotJ¢.� s© CI,- V T , z3,1 ( ui(_re me-7 '** atv�v" s(g , i 1:41-c0> — RECEIVED Commanw°a[th 7 h Official Use Only J . L, 'PR 0 4 2022 c aaaac aea(fe y a+' �spgrtmanf el' s' Permit No. - v Jt6 �� 1( .rvu.a ". ''t L D I t Occupancy and Fee Checked _ ;% Ok 'L'� i�� 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: Lf-- 'f—a--D')-- City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or intention to perform the electrical work described below. 4 Location(Street&Number) / / Owner or Tenant ' f 4't't''` ( k`,` t= lz-�,,t, � i� yi � t.."1 Owner's Address Telephone No. S��a _� f Is this permit in conjunction with a building permit? Yes ❑ No �•-� � C � Purpose of Building t_�•� (Check Appropriate Box) Utility Authorization No. Existing Service �Amps / /LTA Volts Overhead O New ervice 0 Undgrd No.of Meters Naw Se--_ Amps / Volts Overhead❑ Undgrd Und Number of Feeders and Ampacity g ❑ No.of Meters -Q_4-0-" �9.-LoflU and Nature of Proposed Electrical Work 91-0 7 fri_g t�, v ,..,_,ee. — f u Cam,letion o the ollowin_ table m be waived b the Ins,ector o Wires. (s! No.of Recessed Luminaires .! No.of Cell:Susp.(Paddle)Fans °•° ota '=a No.of Luminalre Outlets Transformers KVA �� No.of Hot Tubs Generators KVA 4't" No.of Luminaires ove n- 'o.o Units cy g rn Swimming Pool ,ri d. ❑ ;` No.of Receptacle Outlets nd ❑ Bane Units g No.of Oil Burners FIRE ALARMS No.of Zones c: No.of Switches No.of Gas Burners `o.o t etec on an 11` No.of Ranges Initiatin,_ Devices No.of Air Cond. ota Tons No.of Alerting Devices No.of Waste Disposers eat 'ump `um er ors ' Totals: ......_...._...._._....._........._... o.o e - onta ne, No.of Dishwashers Detection/Alertin Devices Space/Area Heating KW Local 0 'un crp No.of Dryers Heating Appliances ecu Connection �� `o.o "a er KW ty ystems: Heaters KW o.o `o,o No•of Devices or E,uivalent Si:ns BallastsNo.Data of Devices ng: No.Hydromassage Bathtubs No.of Motors a ecommunfe cae or Bns •uivalent Total HP No.of Devices or E uivalent OTHER: � Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: Work to Start: L`_ e-- (When required by municipal policy.) INSURANCE COVE Inspections to be requested in accordance with MEC Rule 10,and upon completion. 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND 0 OTHER I certify,under the pain and penalties o 0 (Specify:) FIRM NAME: � fPeriury,that the information on • 'cation is true and complete. Licensee: t' LIC.NO.: Signature �/6 IS afapplicable enter"e a t"in the I' a numbe line.), LIC.NO.: t Address: '�t'} .L. *Per M.G.L.a 147,s.57-6I,security work requires Department Bus.Tel.No.: .i'�� ySy_ 17 OWNER'S INSURANCE WAIVER: I am aware that heLicensee does Safetyot have the liability insuranceAlt.Tel. o required bylaw Bymysignature "S"License: Lic.No. Owner/Agent below,I hereby waive this requirement, I am the(check one [] coverage normally Signature owner ■ owner's a:ent. Telephone No. PERMIT FEE:$