Loading...
HomeMy WebLinkAboutBLDE-22-004574 0. Commonwealth of Official Use only �` Massachusetts Permit No. BLDE-22-004574 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:2/17/2022 City or Town of: YARMOUTH To the Inspector of Wires: 7.,:.\:\I 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 �' i ,- "�^.,q 71 Owner's Address RUBENSTEIN SANDRA B, 20 LINNELL LN,YARMOUTH PORT, MA 02675 14 ?F ; ' ,.' - Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate$ tt) a , , Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of M New Service Amps Volts Overhead 0 Undgrd 0 No.of Me Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement generator&transfer switch. 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 1 KVA 20 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 Initiatine 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 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 Ballasts Data Wiring: Heaters Siens 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: 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: $100.00 C..ommonwea[tt/ o//i`lamactxuaettt Official Use Only Z 74-71 .1J C. Permit No.( 7, t. 7 ¢/1 apartment of ire Services " Occupancy and Fee Checked �Pa BOARD OF FIRE PREVENTION REGULATIONS Rev. am` (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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: T t S l U i -b d j- City or Town of: yet fr,o"7 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) 30 I i nnti Lone... Owner or Tenant M/bt n S}t, /i Telephone No. SO 8 732 G 6,3 Owner's Address c.O I i n a t j l 1 ct n Y... Is this permit in conjunction with a building permit? Yes ❑ No ,-Er (Check Appropriate Box) Purpose of Building (-rod-t al,ti. 1 Utility Authorization No. Existing Service a(i° Amps t o / )1-4°Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd n No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: F.t.(l c1C(.C►t n► 6 e n t t a}Or f -�1''1n)F1( j-, c"I 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 I Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 21, Above ❑ In- i—i❑ No.of Emergency Lighting No.of Luminaires Swimming Pool 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 - Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ 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 Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.ofMotors 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 Electrica Work: -3,(t&o (When required by municipal policy.) Work to Start: (K5 ►9"i 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 ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjuty,that the information on this application is true and complete. FIRM NAME: -n©rr,:a K-l.a-Itr.c'Ll jKt If,cis In L LIC.NO.: 01 I5a- A Licensee: An 4ctw 'note 6.- Signature �'e.---- LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 61 i 7 - 5 - ) Address: 7 EC v i a r1 tAlt.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: 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 Signature Telephone No. PERMIT FEE: $ 1