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HomeMy WebLinkAboutBLDE-23-005520 Commonwealth of Official Use Only 't. , Massachusetts Permit No. BLDE-23-005520 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) 39 UNCLE ROBERTS RD Owner or Tenant ZALDASTANI ELIZABETH(EST OF) Telephone No. Owner's Address 42 CABOT ST,WINCHESTER, MA 01890-2420 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: Rearrange laundry&mud rooms.Wire gym in basement. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 18 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 9 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tn Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Space/Area HeatingKW Local 0 Municipal 0 Other: No.of Dishwashers P Connection No.of Dryers 1 Heating Appliances KW Security Systems:* ryNo.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent 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: (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 LIC.NO.: 15717 Licensee: Jay A Donnelly Signature (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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. (PERMIT FEE: $75.00I S?- 56.,111 de/Z-7 1 --- aoV- (11(1/ RECEIVED APR AU,, 2023 Comunm„tvaak at Ma66aclugudlo Official Use only __ _ Permit No. ��✓ - 7� BUILDI j TMENT 2epar�snlof.tamSsruw.l By;____ \ °`� __--- Occupancy and Fee Checked 'k,� 'e BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (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 E ALL INFORMATION) Date: 3—t 'c 3 City or Town of: g retire To the Inspector of Wires: By this application the undersi gives notice of ' or her intention to perform the electrical work described below. Location(Street&Number) 39&,,,,,,,e„I)F'C i5 £D- Owner or Tenant, /Z2A-barii zA/Diermai Telephone No. Owner's Address 4d, &9)( L9/ rn?LJ 14' 0/I;4, Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building fr ./9470Ce. Utility Authorization No. Existing Service a Amps /2/i g i/6Volts Overhead❑ Undgrd Ur No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 6e hA uv 4f IA eat ~ ,M. eti i ym i J A3 11f - r Comrpletion of thefoiowing ab o am be waived by the Inver r of Wires. Total No.of Recessed Luminaires No.No.of CeLSusp.(Padre)Fans Transff ormers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Swimming Pool ❑ ❑ 1vo.of ,units Lighting No.of Luminaires Aboved I>crnd. Battery UniBts� No.of Receptacle Outlets /© No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No,of Gas Burners No.Initial f Detection Devices ' ' No.of Ranges No.of Air Cond. Ton` No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW_ No.of,Selfd-Container Totals: No.of Dishwashers Space/Area Heating KW Local 0 Connection 0 Other No.of Dryers Heating Appliances KWy Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heater Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs Na of Motors Total HP Telecommtudcations, REa�® ►aleot 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: .5--30-01.3 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 fil BOND 0 OTHER 0 (Specify:) I cur*,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: —Tr A, OOIV k j 11 J I/7 C LIC.NO.: ,/W712 Licensee: 7$1 DONjOgl( Signature L .v LIC.NO.: y alG (If applicable,enter in the license line.) / Bus.Tel.No.:7,11' G 998 Address: /c��/ /,Zd ':7: R,Yi01 1 1 t` O&76' Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent SignaturetuneTelephone No. PERMIT FEE:$ 7S' Q NN °I7