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HomeMy WebLinkAboutBLDE-23-003672 a' Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-003672 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:1/6/2023 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 des •bed bqlpw. , p Location(Street&Number) 50 BROADWAY (�.,/J 9 Owner or Tenant BOGAR AGNES E TR Telephone No. Owner's Address OFF BROADWAY REALTY TRUST, PO BOX 38693, GREENSBORO, NC 27438 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: Kitchen remodel 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 El 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. Totalo No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection ❑ Other: No.of DryersHeating 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.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: Scott A Souza Licensee: Scott A Souza Signature LIC.NO.: 14663 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:307 SCONTICUT NECK RD, FAIRHAVEN MA 027191409 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: $75.00 I 0 i I 1 e(2.3 le -' ' e• d 3( (4j 3 RECEIVED ��// // Official Use Only CaCommonwealtho� a laachu teEl t [7:-JA cc�� e�77 Permit N �� `'3� l - I- `d 3epartinertt a/ ire Serviced BUILDIN ENT Occupancy and Fee Checked By: ARD OF FIRE PREVENTION REGULATIONS [Rev. 1,07] (leave blank) Gv \03D APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5?7 CMR 1?.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /—l5- Z-5 City or Town of: 1 ii li p() i k. 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) $0 /RoA DCi)"A i/ Cie..5 r Kg,c/vtocir Owner or Tenant AS /1-1e / 4'5 ((�� Telephone No. 7?c1C9'7 ' 97/.5 Owner's Address / 7 /jo7 'SS 6,J,3 6frf.:74S64,7-0 /LIC - "S g'6 / J Es this permit in conjunction wit6 a building permit? /'Yes 0No E (Check Appropriate Box) /Z. Purpose of Building 7dicit jec e4if/e'/ Utility Authorization No. Existing Service/ V Amps /v©/ ,71/5 Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity f—/ice Location and Nature of Proposed Electrical Work: // of /'leek�e/ 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 Above In- O. of Emergency Lighting No.of Luminaires Swimming Pool arnd. 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 p Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* rY No.of bevices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts 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: 3C`3 (When required by municipal policy.) Work to Start:(-]--Z3 Inspections to be requested in accordance with NIEC 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 31i BOND 0 OTHER ❑ (Specify:) I certifj', under the tins and penalties of perjtuy�, that the information on this application is true and complete. FIR%I NAME: Ay // C/�,G=l c rrt 6,4/i /G I ee,s 4 LIC.NO.: O Licensee:50: ScrL ft Signature /� LIC.NO.: / �P 4 Lice l G� ("If applicable, enter "exempt"in the license• niether livye.) Bus.Tel. No.:77 rf 91 17/.S Address: 307 ,'eoATJcaT N14 i, 0141D 14-iyehhtle41114 0-7 t 7 Alt.Tel. No.: *Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does nor here the liability insurance covera`e normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ o..%ner ❑ owner's agent. Owner/Agent I PERMIT FEE: S 75'`x' Signature _ Telephone No. _