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HomeMy WebLinkAboutBLDE-23-002772 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-002772 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) 2 City or Town of: YARMOUTH Date:1To the Inspector of By this application the undersigned gives nonce of ,s or her intention to perform t e e ectnca work described below. of Wires: Location(Street&Number) 122 EXETER RD Owner or Tenant STEVE BICKERTON _ ®2 g Owner's Address Telephone No. Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate B x Existing Service Utility Authorization No. \ � 2 Amps Volts Overhead ❑ No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd Undgrd 0 No.of Meters Number of Feeders and Ampacity 03, Cigj Qfan i as Location and Nature of Proposed Electrical Work: Local wirin for modular home to include service&re-bar roundin . 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 • No.of Luminaire OutletsTran fo •rs Total No.of Hot Tubs V Generators KVA No.of Luminaires Swimming Pool Above ❑ In_ rnd. rnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets Batt• its No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total •Matt ' I evices No.of Waste Disposers Heat Number TO No.of Alerting Devices Tota s:Pump Tons KW No.of Self-Contained No.of Dishwashers --- t• ',n A • 1 •v. Space/Area Heating KW • Local 0 Municipal 0 Other: No.of Dryers Heating Appliances •nne Yon No.of Water ' Security Systems:* Heaters ' No.of •.of D•v e or • i al•nt i �s No.of Ballasts Data Wiring: No.Hydromassage Bathtubs NI. if l • is• or o i a •nt No.of Motors Total HP Telecommunications Wiring: OTHER: '. i f 1 •v'ce 'r 'ui al• t Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) 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 is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE 0 coverage BOND 0 OTHER 0 (Specify:) rr^7�QQ I certify,under the pains and penalties o ica Z L� �22- © f V FIRM NAME: (perjury,that the information on this application is true and complete. William F Dougherty Licensee: William F Dougherty Signature (If applicable,enter"exempt"in the Zicense numbMer line.) Bus Address:6 LOWELL DR, ORLEANS MA 026534841 Tel. NO.: 13932 M.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. Signature Telephone No. 1((24 ! `� PERMIT FEE:$230.00 4 _� > ps sl7P�C� - t, nc�ia Alt v�r R G n i(vc,( i ( I fIC ito vi �e NOV 17 2022 4 3 � y� / '_ ; DING DEPART tvTt N T �v°R o� adaachrceo([a c >g `7 .r fficial Use Only r 2 t .�11 2+rttrimsni el34.a S'srvicsd Permit No. . _— �- ',, ; ` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked " ;Rev. 1/07] leave blank ----.________ ) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code EC 527 CMR 12.00 T (PLEASE PRIIN INK OR TYPE ALL INFORMATION)City or Town of: YARMOUT ZDate: // /By this application the undersigned gives notice of his or her intention to perform the electrical work described below. To the Inspector of Wires: Location(Street&Number) 2 2, Y Owner or Tenant SI s i r O i Owner's Address li Ed Telephone No. 11 Is this permit in conjunction with a building permit? " � Purpose of Building tt�� rn I'm ty ❑ (Check Appropriate Box) Existing Service Utility Authorization No. Jp Amps / Volts New ervice ZOD 2— Overhead 0 Undgrd 0 No.of Meters _ Amps 40 /JZO Volts � I Number of Feeders and Ampacity Overhead❑ Undgrd No.of Meters �_ Location and Nature of Proposed Electrical Work: ` 2��'M G d' �it,eJti a/�✓✓ Mote covreitiOn4 ,Ev `�' No.of Recessedkei Completion o the ollowin• table m `, Luminaires No.of Ceil:Sus . o.o be waived b the l KVA ector o lf'ires, f i No.of Luminaire Outlets p (Paddle)Fans ota No.of Hot Tubs Transformers KVA Na.of Luminaires Generators KVA Swimming Pool rnd ove ❑ n- 'O.o mergency g n ti No.of Receptacle Outlets ' nd. ❑ Batte Units g No.of Oil Burners FIRE ALARMS No.of Zones b= No.of Switches No.of Gas Burners `o.o t etec r on an ' No.of Ranges Initiatin Devices No.of Air Cond. ota No.of Waste Disposers Tons No.of Alerting Devices 'eat 'ump `um i er ons Totals: ............_...._._....... o.o e out nee No.of Dishwashers Detection/Alert Devices Space/Area Heating KW 'un ci a No.of Dryers Heating Appliances Local 0 Connection 0 Other `o.o "a er KW ecu ty y s Heaters KW 'o.o No.of Devices or E uivalent o.o Datag' Wiring: Si.ns Ballasts No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP e ecommun car ons '" r ,g: OTHER: No.of Devices or E r uivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lee ical Work: Work to Start: /( 17 1�ZZ (When required by municipal policy.) INSURANCE C VE Inspections to be requested in accordance with MEC Rule 10,and upon completion. GE: 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: INSURANCEA BOND 0 OTHER I certify,under the pains and penait[es orp j er u ❑ (Specify:) FIRM NAME; rJ',that the information on this application is true and complete. Licensee: /"�,1, GY LIC.NO.: (/fapplicable,ente a em t" Signature Address: th cense nu er line.) LIC.NO.:19.32" *Per M.G.L.c. 147,s.57-ti 1,security work requires e OZ�S3 Bus.Tel.No.:77 •'2 7 p/ OWNSOWNER'S INSURANCE WAIVER: I partrtient of Public SafetyAlt.Tel.No.: b law. Byam aware that the Licensee does not have the liability insuranc coverage normally orequire Y my signature below,I hereby waive this requirement. I am the(check one Owner/Agentd Signature � owner ■ owner's a:ent. Telephone No. PERMIT FEE:$ 210.