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Home My WebLink AboutBLDE-23-004544 s- Commonwealth of Official Use Only . , ! Massachusetts Permit No. BLDE-23-004544 \ ' 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:2/15/2023 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 described below. Location(Street&Number) 31 CHECKERBERRY LN Owner or Tenant ROGER SAMPSON Telephone No. Owner's Address 31 CHECKERBERRY LN,WEST YARMOUTH, MA 02673 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: Septic pump&alarm 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 0 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 No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices 1 No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent KW No.of No.of Ballasts Data Wirin Heaters Signs g' No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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 0 OTHER 0 (Specify:) Q I certify,under the pains and penalties operjury,that the information on this application is true and complete. � �f "�� j f pp 7 FIRM NAME: MICHAEL F SIMONIS Licensee: Michael F Simonis Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 16862 Address:PO BOX 1488, EAST DENNIS MA 026411488 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 t, I PERMIT FEE:$50.00 V1Z% Conunonwealtk el7aaoaclumas Official Use ,ly ,•,., 'u ' c� Permit No. z5L—1- 2spar ni of s Kos E (. + Occupancy and Fee Checked u BOARD OF FIRE 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 V (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: „7/'// 3 City or Town of: y,12-2 "i e7 c/'Ty{ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. U Location(Street&Number) '3/ CA e G,L ey-2S-e/'r'r G 4.-,t- Owner or Tenant X e> 7 .e� -5-1-7'-1P S'orj Telephone No. Owner's Address 5. -rtii -e Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) G F art ose of Building rS',- ie 4-7Yt 2)srv-c 4,1 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters 0 New Service Amps / Volts Overhead 0 Undgrd El No.of Meters Number of Feeders and Ampacity ,V Location and Nature of Proposed Electrical Work: �// e �Z',r e L 7'rrri j t'''' t a Ale-,6i I -e/ -¢4--.-¢-/-.n r Completion of the followingtable my be waived by the Inspector of Wires. Total �, No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Transformers KVA CA No.of Luminaire Outlets No.of Hot Tubs Generators KVA a No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting fund. 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 i _ Initiating Devices tal ' -' No.of Ranges No.of Air Cond. To No.of Alerting Devices No.of Waste Disposers -Heat Pnmp Number.,„Tons ..._KW_____ No.of Self-Contained Totals: Detection/Ale , ,. Devices No.of Dishwashers Space/Area Heating KW Local❑ Man y 0 Other Connection No.of Dryers Heating Appliances KW Security Systems:I' No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or '. - t No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsofDevices r ' E No.of Devkes or Eau : ,t OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical ork: (When required by municipal policy.) Work to Start: 21/y23 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 Itcensee 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 EYBOND ❑ OTHER 0 (Specify:) 7 r--.4-✓e/-e-``.s I cer*lfy,under the pains and penalties of pedouy,that the information on this application is true and complete. FIRM NAME: .5'1 0'irS , 2-e• f-`rc , z ? LIC.NO.: 4 147 r(a2 L1censee:/ r J?,r4.€/ ,-+? •'tS Signature,/ LIC.NO.: .3 457 3,F (Ifapplica le,enter"exempt"in the license number tine �K e4��7 ._._I Bus,TeL No.t Address: 7 ° .W®X /7. 's' &-.. �e•?Ois �f-r� /,... `ff Alt.TeL No.: *Per M.G.L.c. 147,s.57-61,security work requires Department ofPublic 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)0 owner 0 owner's agent. Owner/Agent a� Signature Telephone No. PERMIT FEE:$ Sp