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HomeMy WebLinkAboutBLDE-23-002110 Commonwealth of Official Use Only Lam'i Massachusetts Permit No. BLDE-23-002110 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.1/071 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:10/20/2022 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) 233 PLEASANT ST Owner or Tenant GRIMES THO t4 4 r Telephone No. Owner's Address CIO rt_ i"' E,233 PLEASANT ST, SOUTH YARMOUTH, MA 02664 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 ❑ 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: Fire&security systems. 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 ❑ Irnd. ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool l; Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones 2 No.of Switches No.of Gas Burners No.of Detection and 16 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices 2 Ton No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices 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 Devices or Equivalent KW No.of No.of Ballasts Data Wiring: Heaters Sins 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 I certify,under the pains and penalties o per jury,, er u that the information on this application is true and complete. FIRM NAME: RICHARD S KUUSELA Licensee: Richard S Kuusela Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 224 Address:379 MONOMOSCOY RD, MASHPEE MA 026494504 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 0 owner's agent. Owner/Agent Signature Telephone No. / PERMIT FEE:$50.00 I r‘61/42 / k Nil g 7: 2w_ tr' Cet (41 0 3 - U Only , �_ The Commonwealth of Massachusetts /('' 1, --- • e1 S Department of Public Safety Permit No. l I CIO . 1l 3• Occupancy& Fee Checked ' � BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date — t _ 7 City or Town of AQ--AO'CWa1 for of Wires: The undersigned applies for a permit to perform the ele rical work described below. Location (Street b Number) Z.3 PVEYCL•YeCil..4\-- ��- s" Owner or Tenant IT,- S"-Iyn��e..._5L Owner's Address �yey��� Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building 3ct_S C ��� Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Vo lts olts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work --}---t o. ( x::� ._ \ ..eyv No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total RvA No. of Lighting Fixtures Swimming Pool bove In- A ❑g grnd. rnd. 0 Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No: of Zones jr... No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No. of Heat Total Total PCPs Tons KW No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑Municipal her No, of No. of Connection No. of Water Heaters KWSigns Ballasts Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Li ( lit Insurance Policy including Completed Operations Coverage or its substantial 14 equivalent. YES NO( I have submitted valid proof of same to this office. YES❑ NO 0 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND ❑ OTHER 0 (Please Specify) Estimated Value of Electrical Work $ ��� (Expiration Date) --lab Work to Start\c r.0 - 0.7„. Inspection Date Reque Fi Rough 2 g nal Signed under the penaltie:l of perjury: FIRM NAME A` d4t,..1-LL, IW Y k -t--C-> /'''4 LIC.:*0 .� Licensee i . Signat e Addres� �n Q>� 1 �' IC. N0. -`771� -v ` t. Tel. No. "� ©.�, ` OWNER'S INSURANCE WAIVER; Ite Alt. Tel. No. �� � y` stantial equivalent as required bya Massachusetts iGeneral censee dLaws,oes oandt athatve hmye i signature nsurance conethis permit sub- application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent Telephone No. PERMIT FEE S