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HomeMy WebLinkAboutBLDE-21-007594 Af)) Commonwealth of Official Use Only �� Massachusetts Permit No. BLDE-21-007594 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:6/29/2021 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) 18 PINE CONE DR Owner or Tenant KELLIHER DAVID A Telephone No. Owner's Address KELLIHER SUSAN D, 345 W HARTFORD AVE, UXBRIDGE, MA 01569 Is this permit in conjunction with a building permit? Yes 0 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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring for TV, Cable, &gas fire place. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: No.of Total Susp.(Paddle)Fans 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 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 p Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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 Siens Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g 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: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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 Quail+ 9/g 24 f / Mk `V3(z/ . .A c( ' h ([e ;35s4A-0 Commonwealth o`Maseachuaeita Official Use Only '' 't c� c� {� Permit No. �� '_, 2)sivarfmsni ei ire Servicse ., 1 i-, Occupancy and Fee Checked ._..r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELEC RIC L WORK All work to be performed in accordance with the Massachusetts Electrical Code(M ) 52.7.E R 2A (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: J3 City or Town of: YARMOUTH To the Inspect r of Wi By this application the undersigned ive otice of his or her inttentio /perform tjle electri work described below. Location(Street&Number) (! Owner or Tenant �q` ,' 7-91// r( " Telephone No. Owner's Address Is this permit in conjuuc with a t ding permit? Yes gi No ❑ (Check Appropriate Box) Purpose of Building �'.�� /f Utility Authorization No. Existing Service Amps ((( I / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ' Number of Feeders and Ampadty 1 Location and Na7re of roposed Electrical Wo k: • VI t. en 5 fil'-p19° Completion of the following table may be waived by the Inspector of Wires. vo Ui 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 Poo swimming l Above In- No.of It mergency Lighting rnd. ❑ trnd. ❑ 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 z Initiating Devices l l' No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons 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 Munidpalnnection 0 Other Co 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: 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 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 of perjury,that the information on this application is true and complete. FIRM NAM / LIC.NO.: Licensee: ' L Si atur , : 3c6�� . gn LIC.NO.. (If applicable, t J,e/lmpl"m th tic um pr line.) y� Bus.Tel.No.: Address: b'r ° l f. It/" „/© 4�- Alt.TeL No.:77 ��°- ?t( *Per M.G.L.c. 147,s.57- ,security work requires Dep t of Public Saf "S"Lice se: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the icensee 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 0 owner's agent. Owner/Agent 5-0Signature Telephone No. PERMIT FEE:$ cE