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HomeMy WebLinkAboutBLDE-22-006717 41A Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-006717 Itti;7 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 O 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:5/20/2022 o • �,. City or Town of: YARMOUTH To the Inspectorit.By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 197 PINE GROVE RD Owner or Tenant Michael Madden Telephone No. aefr„ Owner's Address 4 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate 0o Utility Authorization No. Purpose of Building � 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: Remodel kitchen, living room &two bathrooms. 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 ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool ❑ In- grnd. grnd. Battery Units No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Detection and No.of Switches 12 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 ❑ Municipal No.of Dishwashers 1 Space/Area Heating KW Local Connection 0 Other: Security Systems:* No.of Dryers 1 Heating Appliances KW No.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: EDWARD M LYNCH LIC.NO.: 35609 Licensee: Edward M Lynch Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 *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 'PERMIT FEE: $75.00 I Signature Telephone No. reci,-.41- <'-i q fry r ;-eG -fir TLI-esd 2 .14 ' RE ; EIVED MAY 77.q",J 2 �h o�1// h Official Use Onl..� iommonwsa aaeac ueaffe y °`. t Z2 (�� ( 7 Tif« _.. cc�� c-� nnPermitNo.BUILUIN '�!<, : ENT .l.Jspart.menf o/. irs Jsrvresd aY. a Occupancy and Fee Checked ` RD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELE TR AL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME 527 MR 12 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YAR OUTH To the Inspe or o Wires: By this application the undersign i notic his o her' ention to perform el t cal w rk described below. Location(Street&Number) Owner or Tenant A 1 G qe a ,e4. Telephone No. fi l Owner's Address WM . Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) 1 Purpose of Building Utility Authorization No. 1 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity ,/J Loccatio apd Nature of Proposed Electrical Work: IrI f e;.4 1 cif t-�14g �(OB� 7'u'o fiar J iiire/i 5 Completion of the followingtable m be waived by the Inspector of Wires. �u No.off Total U. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA ':-,1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA ,.t,. No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting grnd. ❑ grnd. ❑ Battery Units �" No.of Receptacle Outlets t c No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches J No.of Gas Burners No.of Detection and Initiating Devices 1 g No.of Ranges / No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ � Connection No.of Dryers /r Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts 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: 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 BOND 0 OTHER ❑ (Specify:) I certify,under the pains and nalties of perjury,that the informatio on this application is true and complete._� FIRM NAME: �f LIC.NO.:,/j Licensee: 4,Jg42/)J /tf� G� Signature //'/ kfiet LIC.NO.: (If applicable, !y(er N xeyr gtr ' rp t ele er!me.) / di Bus.Tel.No.:77 if— %,-ene Address: f• /V�IK_� © e e f Alt.Tel.No.: *Per M.G.L.c. 147,s.57- 1,s urity work req Tres Departm of ubiic Safety"S" ice : Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Li cnsce 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)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ S ,Cw