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HomeMy WebLinkAboutBLDE-23-004735 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-004735 j. 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:2/27/2023 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) 20 LINNELL LN Owner or Tenant RUBENSTEIN WILLIAM M Telephone No. / Owner's Address RUBENSTEIN SANDRA B, 20 LINNELL LN,YARMOUTH PORT, MA 02675 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: Ductless heat pump.(Camp grounds) 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 grad. 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 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: 1 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 Eauivalent 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 Eauivalent 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: ANDREW G THOMAS Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 ECHO LN,CHATHAM MA 02633 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: $80.00 R ' b ("j (7,.g' &- pp Official Use Only �ommonwealt�o� ae�ac�ueett� L I� •—' trff_ & ',I. cc-� c7 Permit No. l�/�// !� MT epartment el ire Services '� Occupancy and Fee Checked g_ BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07 (leave blank) -M�w APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: IC.13 ao) a°A City or Town of: Y A(hovZ't To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) a 0 .Li ni1 ti 11 \a A t- Owner or Tenant Rtl S tit S-tt a Telephone No. Owner's Address a.p Line e11 taut Is this permit in conjunction with a building permit? Yes E No Z (Check Appropriate Box) Purpose of Building (e-544,4 f« t Utility Authorization No. Existing Service tC)D Amps \v?d / W o Volts Overhead Undgrd 2. No.of Meters l New Service Amps / Volts Overhead n Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: j ,1 L Q V Ole$S tie ki f U M Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units I No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No. of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: t a Detection/Alerting Devices Municipal l No.of Dishwashers Space/Area Heating KW Local 1-1 Connection ❑ Other HeatingAppliances KW Security Systems:* No.of Dryers pp No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KWBallasts No.of Devices or Equivalent Heaters Signs 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: 1l vb 0 (When required by municipal policy.) Work to Start: f tib a0?D . 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 IZ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. a I��, FIRM NAME: ll,ots�S E1t Gir.ckl S t(Vi(,AS S.w C.. LIC.NO.: 1ypp,a,f Signature LIC.NO.: Licensee: /91�(ty "1" (If applicable, enter "exempt_in the license numbernber line.) Bus.Tel.No.:(pl 7-Vs'B l I l Address: 7 Alt.Tel.No.: tctio tans e.k.tTl7aty M°; ©ail3 *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public 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)❑owner ❑ owner's agent. Owner/Agent Telephone No. I PERMIT FEE: $ Signature