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HomeMy WebLinkAboutBLDE-22-006800 Official Use Only -- Commonwealth of Massachusetts Permit No. BLDE-22-006800 a.o,.a 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:5/24/2022To the Inspector of Wires: City or Town of: YARMOUTH By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 24 CROWELL RD Telephone No. Owner or Tenant HOUSTON THOMAS C Owner's Address 24 CANOE RIVER RD, SHARON, MA 02067-2977 Appropriate Box) Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Utility Authorization No. Purpose of BuildingNo.of Meters Existing Service Amps Volts Overhead 0 Undgrd 0 New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Generator&two condensers. . Completion of the following table may beiv ivez b the Inspector of Wires. No.of Total No.of Ceil.-Susp.(Paddle)Fans NoansformersVVVV//J KVA No.of Recessed Luminaires �Y((// KVA No.of Hot Tubs Generators 1 No.of Luminaire Outlets No.of Emergency SwimmingPool Above In- ❑ No.of Luminaires grnd. ❑ grnd. Battery Units Utility?! No.of Oil Burners FIRE ALARMS INo.o No.of Receptacle Outlets ":* No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. 2 Tons Heat Pump I Number I Tons I KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Local ❑ Municipal ❑ Other: Space/Area Heating KW Connection No.of Dishwashers Security Systems:* Heating Appliances KW No.of Devices or Equivalent No.of Dryers No.of No.of Ballasts Data Wiring: HeNo Water KW Signs No.of Devices or Equivalent Heaters 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 qf 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. f work may issue INSURANCE COVERAGE:Unless waived by the owner,no permit for its s ibstantial equ�alenttrTl el undersigned gt ed certitfiessths at such tcovesee pageides proof of liability insurance including"completed operation"coverage or is in force,and has exhibited proof of same to the permit issuing office. S ecif CHECK ONE: INSURANCE 0 BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: NEIL SCHOENER LIC.NO.: 13949 Licensee: Neil SCh (If applicable,enter"exemmptpt""in Signature n the license number line.) Bus.Tel.No.:Alt.Tel.No.: Address:44 TRADERS LN,W YARMOUTH MA 026733333 *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❑theoliiabil ity❑insurance 'coverage normally required by law.But my ner s t. signature below,I hereby waive this requirement.I am the(checkone) Owner/Agent PERMIT FEE: $75.00 Telephone No. Signature (1--01-ZNai f'' et*DUt T -Civi**27 Commonwealth o/'I7addac4u4alie Official Use Only ''T:'7111 Permit No. €00 ,s. -., 2spartmnt of ins Jarvicsd j- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) ti APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK )s- All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527��[CMR 12.00 f' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: `f - Zl7�2 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives otice of his or her intention,, � to perform the electrical work described below. V Location(Street&Number) 4 G roWLtt JLOL (A)(� j�/'�°I't©(lJ�'7 j Owner or Tenant ^b d'✓\ I+OL25Tt),� Telephone No. Owner's Address ! Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) 1 Purpose of Building 6--'1i tit,e 2_ 4.<2 Ca hunt?,-, Utility Authorization No. ExistingService .2 C Amps ) Lf7/ 2 LiO Volts Overhead Undgrd❑ No.of Meters / New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters o� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Wor/yk:IW it pe..t. 06 &etc(.-vl l ,-vc�rail•'L A AIL% filti k!i �V/ Completion of the followingiable m be waived by the Inspector of Wires, '`A No.off Total ti.? No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA 14 No.of Luminaire Outlets No.of Hot Tubs Generators KVA r--:' Above In- No.of Emergency Lighting t No.of Luminaires Swimming Pool�rnd. ❑ grnd. ❑ Battery Units y No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and h Initiating Devices s No.of Ranges No.of Air Cond. Tony) No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW- No.of Self-Contained p Totals: _ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal rn 1-1 Other Connection No.of Dryers Heating Appliances KW Security s:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Ens quivalent irinNo.Hydromassage Bathtubs No.of Motors Total HP Tel No. f Devices oor Equivalent OTHER: 4 � U Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: bl7 (When required by municipal policy.) Work to Start: 5 ?3 -2,4 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waiv by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability i ranee including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I certify,under the pains a&d penalties of perjury,that the information on this application is true and complete. FIRM NAME: I) Z t 1 S'G V►oe. :->2 s' • LIC.NO.: (,j 94? Licensee: Signature-,'fie' . LIC.NO.: (If applicable,enter' x mpt"in the license number line.) Bus.Tel.No.: L-" Address: y T t—i ?!LS (Ave_ WI,i 1''°c."f' Alt.Tel.No.: ✓U��7�' i�$ *Per M.G.L.c. 147,s.57-61,security work requires Department o ublic 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 PERMIT FEE: $ Signature Telephone No.