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Home My WebLink AboutBLDE-23-003259 ��S Commonwealth of Official Use Only� ry` i Massachusetts Permit No. BLDE-23-003259 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:12/12/2022 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) 72 SILVER LEAF LN Owner or Tenant GOLEBIOWSKI STEVEN M Telephone No. Owner's Address GOLEBIOWSKI SUSAN E, 18 WETHERELL STREET,WORCESTER, MA 01602 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 Number of Feeders and Ampacity gNo.of Meters Location and Nature of Proposed Electrical Work: Finish section of basement. (800 Square feet) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 16 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 A bove ❑ Irnd No.of Emergency Lighting rnd. Battery Units No.of Receptacle Outlets 19 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 4 No.of Gas Burners No.of Detection and Initiative Devices No.of Ranges No.of Air Cond. Total Ton No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alertine Devices 1 No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Ballasts Data Wiring: Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 1 OTHER No.of Devices or Equivalent 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, is er u that the information on this applicationtrue and complete. FIRM NAME: Clint W Kelsall Licensee: Clint W Kelsall Signature LIC.NO.: 28822 (If applicable,enter"exempt"in the license number line.) Address: 168 CEDAR ST, W BARNSTABLE MA 026681332 Bus.Tel.No.: Alt.Tel No *Per M.G.L.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. Signature Telephone No. PERMIT FEE:$75.00 I2CLi 64 /z A i/2?44",.- 0M1._. '/ 'L ;lrs'(2 K RECEIVED . ;i DEC 12 2022 o awsallfs o�///asaar !`fs Official Use Only ail_ ; parfinent al. ire Serviced Permit No. -1 i I-D F PREVENTION REGULATIONSOccupancy 1/07cy and Fee Checked _ "By ---- — — •ev. 1/D7] eave blank APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE ALL INFOPL1TIO C)>527 2. l z.00 City or Town of: �'ARMOUTHm To Date: ,a. �2 . oz ec or of rres: By this application the undersigned gives notice of his or her intention to perform the�ctrical work described below. Location(Street&Number) 7.2 5/Lt ,e,' L,,ce. Owner*or Tenant SrT' t 1 G.�� d�_� 0,E�l .SvS.E.`/'Gd'Ge.i7iGta.-1SK= Telephone No. Owner's Address /6 Ls> (-4.2e: � --.E-STE.e.._ e/40.c:3 Is this permit in conjunction with a building permit? Yes ❑ No . . ❑ (Check Appropriate Box) Purpose of Building 7.2�..1A1.e-,edr.ff-r- Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity ❑ Undgrd ❑ N .of Meters Location and Nature of Proposed Electrical Work Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires /4 No.of Cell.-Susp.(Paddle)Fans No.of Total No. of Laminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- -No.of limergency Lighting _ No.of Receptacle Outlets :rnd. `mod' La Batte units g No.of Oil Burners FIRE ALARMS No,of Zones . No.of Switches No.of Gas Burners o.of Detection and V No.of Ranges Initiating Devices No. of Air Cond. ° Tons No,of Alerting Devices Heat Pump umber Tons o,of elf-Contai No.of Waste Disposers Totals: Detection/Mertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connectioa ❑ Omer No.of Dryers Heating Appliances Kw Security Systems;* No.of ater No.o No.of Devices or E uivalent Heaters o.of Data Wiring: Si s Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Telecommunications Wiring: Total HP No.of Devices or uivalent OTHER; r- Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Wor Do•O (When required by municipal policy.) Work to Start:t.2 . 42 .,2c,„2'tInspections 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 Ry BOND ❑ OTHER 0 (Specify-.) f certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Gb,,clT .44-e- LIC.NO.: Licensee: ��, � _,z �' Signatur �— (If applicable,enter "exempt"in he license number line.) LIC.NO.:� ��.'� Address: LG t✓ _ � Bus.Tel.No.: 4� J `Per M.G.L. c. 147,s.57-61,security work requires Department of Public SafetyAlt Tel.No.: — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLin.No. required by law. By my signature below,I hereby waive this requirement I am the(check one ❑owner coverage normally Owner/Agentjk ❑owner's a ent Signature Telephone No. PERMIT FEE: $ 1