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HomeMy WebLinkAboutBLDE-22-004001 Official Use Only - ti Commonwealth of ,� Massachusetts Permit No. BLDE-22-004001 �T' '......" 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:1/19/2022 To 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) 120 PAWKANNAWKUT DR Owner or Tenant Karen Greig 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. 7633580 Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters - New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service&relocate point of attachment. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd.- ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices Local ❑ Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: 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 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: Michael D Hollister LIC.NO.: 10071 Licensee: Michael D Hollister SignatureBus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:85 N DENNIS RD, S YARMOUTH MA 026641017 *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 otheliability ner ❑s insurance coverage normally required by law.But my s t. signature below,I hereby waive this requirement.I am the(check one) Owner/Agent PERMIT FEE: $50.00 Telephone No. Signature 1-4. tr I (c UQav, MI) 1 12-Li ( V_ W nS rla enied1eL l^ �_ Commonwealth o`Massachusalfs facial Use On( ,_— cc�� �i Permit No. 2Z —1 l 00( .Uapanfarent o/�ira Jcrvitts ='�� , Occupancy and Fee Checked ` r BOARD OF FIRE PREVENTION REGULATIONS {Rev. I/07] (leave blank) A DDI in A Tln►i rr+r+ -- --- _- -. . . ...... t 1. 1xiTII I I v ramrVCGm tLtl; I KIGAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5,27 CMR 12.00 Lb (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /i / 9 /,,, a OCity or Town of: YARVIOUTH To the Inspectrfr of Wires: V By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) /O Pf4-1dc1ef},,,,t/ } ;,/ b 2_ Owner or Tenant �,f�-.��;� (72 R E, j 6, Telephone No. 4� �' i 'ems' tOwner's Address d Is this permit in conjunction with a building permit? Yes _ No 2. (Check Appropriate Box) 4 Purpose of Building es t CD C &- Utility Authorization No. 7& Existing Service/ O Amps / Volts Overhead LZ1 Undgrd❑ No.of Meters I New Service �(.7 Amps / Volts Overhead 0 Undgrd No.of Meters / Number of Feeders and Ampacity 0 j64-,cz 4 ice"` S �Y,k 5 T c, Cc), Location and Nature of Proposed Electrical Work: fv) ✓Y' pa, /y^71— Ll/ . j'77' h"?6 '7` 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 i ,Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of 1 mergency Lighting Q No.of Luminaires Swimming Pool ornd. ❑ mid. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of and No.of Switches No.of Gas Burners f InitiatingDetection Devices No.of Ranges Na of Air Cond. Total No.of Alerting Devices 1 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connectionpp ❑ Other `� No.of Dryers Heating Appliances KW SecurityN f Systems:* Devices or Equivalent No.of Water No.of No. of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No. H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsNofDevicesor Wiring:a Y g No.of or Equivalent 0... OTHER: �� Attach additional detail V.desired or as required by the Inspector of Wires. t Estimated Value of Electrical Work: ?jC > (When required by municipal policy.) t*v Work to Start: )I/ / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COV RAGE: 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 [ik BOND ❑ OTHER 0 (Specify:) kil I certify, under the pains and penalties of perjury, that the information on this application is true and complete. 4 FIRM NAME: In/I.16-14✓l EL /) `-l© L G./5 T '0 LIC.NO.: 7/ Licensee: 1m ,( Wit` Signature LIC.NO.: (If applicabl , entffjj em t/"in a ease number lin ) f �� Bins_C 1:1.:: S0 8' Address: Y/ �!< P101't'/ b c.`a' /�L,t /�G// Alt.Tel.No.: 7 7COS J *Per M.G.L. c. 147, s. 57-6i,security work requires Department of Public Safety"S"License: Lic.No. V — 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)El owner El owner's agent. S Owner/Agent PERMIT FEE: $ l Telephone No.