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Home My WebLink AboutBLDE-23-005519 Commonwealth of Official Use Only IL _ • Massachusetts Permit No. BLDE-23-005519 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:4/4/2023 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) 1170 GREAT ISLAND RD Owner or Tenant ANN VIEBRANZ Telephone No. Owner's Address 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: Wire 3 car garage fed from main house. 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 grnd. grnd. Battery Units No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Slums 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: Jay A Donnelly Licensee: Jay A Donnelly Signature LIC.NO.: 15717 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 158 PINE ST, RAYNHAM MA 027671121 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $75.00 I IN ill/712:7 et .. 77 .,,,,,a_t__ (e/.21(.23 K'''------' 4!2 lcu7 te A 4 511g6> e r RECEIVED ..., o� 21 �p . �m�� Official Use Only L ' ., z3— 1 . ? v 2eparimmnf _/ Permit IrIO. 8 U I L D f N ,� I J' i E N T Occupancy and Fee Checked 3y.— -- :.a. RD OF FIRE PREVENTION REGULATIONS ;'` [Rev. l ro7j peeve wank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusens Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF'ORMATTION) Date: 3 a Q--r City or Town of.• /�5/ IT t To the Inspector of Wires: By this application the undersignedgives notice of his or her intention to perform the electrical work described below. Location(Street&Naaabeer)�LUe 6. i rz,, 104 ,.4 Owner or Tenant / V/( OVEZ3i$PAVZ Telephone No. Owner's Address }C �.P Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Girhe.at6 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: wage- /vats J c../ie --#7p - rev FR-€1 m ill K) ROUSE" L Completion of the follsnvinKtable mT7 be waived by the I7ector of Wires. No.of Recessed I�inaires No.of Cei11.-Snap.(Paddle)Fans No.of ToW Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of I,aminairr3s 9 Sig p� Above ❑ In- ❑ No.of Emergency Lighting grad. Etnd. Battery Units No.of Receptacle Outlets /w No.of Oil Burners FIRE ALARMS ,No.of Zones No.of Switches 3, No.of Gas Burners -"No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Ton` No.of Alerting Devices No.of Waste DisposersHeat Pump Number Tones KW 'No.of Self-Contained Totals:jry _ _�-._.._____. Detection/Ale 4 , Devices No.of Dishwashers Space/Area HeatingKWMuu w . Local❑ Connecdon 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of D e or Equivalent Heaters KW No.of Data Wiring; Signs Ballasts No.of Devices or ulvalent No.Hydrae Bathtubs No.of Motors Total HP T No.of Devices or Eq OTHER: _ Estimated Value of Electrical Work: Attach additional detail if desires'or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start 3-?0— S 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 al BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjary,that the information on this FIRM NAME: �;A. Q?/UXJE/l V�./Ae j/ ' , application is true and complete LIC.NO.: /9/5�,/� Licensee: .�O� r- (lfapplicable,enter Ot(1 �`/Yense number lime.) S ture j LIC.NO.: Address: /��. /4r ' � z)mint 1N14-,0-7Gat,,,, Bus.Tel.No.: 9erite *Per M.G.L.c. 147,s.57-61,securitywork Alt.TeL No.: requires t 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 requi?ed 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. I PERMIT FEE:$ ')� Go— `1997