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HomeMy WebLinkAboutBLDE-23-003793 Commonwealth of Official Use Only A� � Permit No. BLDE-23-003793 ` Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:1/12/2023 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) 23 LEWIS BAY BLVD Owner or Tenant GALLAGHER BRIAN E Telephone No. Owner's Address GALLAGHER JENNIFER A, 2 OLD HARRY RD, SOUTHBOROUGH, MA 01772 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: Miscellaneous work per attached for exterior kitchen. 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 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine Devices Municipal No.of Dishwashers Space/Area Heating KW Local 0 Connection ❑ Other Security Systems:* No.of Dryers Heating Appliances Kam' No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 perjuiy,that the information on this application is true and complete. FIRM NAME: WELLINGTON R SOARES LIC.NO.: 21075 Licensee: Wellington R Soares Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address: 110 BREEDS HILL RD,UNIT 5,HYANNIS MA 026011864 *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 I PERIViIT FEE: $I 50.00 I Signature Telephone No. --- rQ0 1/(4L3 �/ % 1 a ,a-t � c(c7 -7; 7 /(uIr3 (I 11 - cis ' C('.' s ? "ti1° i . 72 /1 t li �i Official Use Only '^. Commonwealth o addac udettd 23 31� cc''�� Permit No. 1 al e artment ofi ire Serviced of P Occupancy and Fee Checked a,� 3OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) EC �,3WORK � �1� a�4� �� R PERMIT TO PERFORM ELECTRICAL Ai:vv ork to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 12.00 _ Y 'R]NT IN INK OR TYPE ALL INFORMATION) Date: !i 12123 •v City or Town of: Y4 N+0(t fri- To the Inspector of Wires: y cation the undersigned gives notice of his or her intention to perform the electrical work described below. b wtur=. ct) Z3 Lew)si P7 l,v ' w ri e1"14 rrl ,pant =Gvs.- -..-- Telephon o. $D,k `3O Uid' '2 S ass �i yi.�l �-' t ill cen`unctioo with a building permit? Yes ❑ No ❑ (Check Appropriate Box) lt:1 Utility Authorization No. imps / Volts Overhead _ Undgrd C No.of Meters Amps I Volts Overhead❑ Undgrd C No.of Meters ♦ c- :w. parity d Electri al Work: i.v IR& ©Ur 0 K�I1:t4 EN till mull 6.v.2 pun in_� 1n� �n vl Young II lie >`6m main hat 40 � r� Completion of the following table may be waived by the Inspector of Wires. No.of Total i;;- sd L atmina t s 1n No.of Ceil:Susp.(Paddle)Fans Transformers KVA � No. of Hot Tubs Generators KVA .No ,rrc Out,_e1:7 Above In- No.of Emergency Lighting INo, .,{ ._. .F_ria�res Swimming Pool grnd. 0 grad. ❑ Batte Units �:: .> .epeacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones r __ . No.of Detection and ,No ,;., . .cues, No.of Gas Burners Initiating Devices Total No.of Air Cond. Tons Neat Pump Number TonsNo.of Alerting Devices KW No.of Self-Contained . . i...Disposers Totals: Detection/Alerting Devices { �___ _.- -. Municipal Other --Washers SpaeelArea heating KW iLocal® Connection ❑ _v Mating Appliances KW Security Systems:* No.of Devices or Equivalent 2� Nr.of No.of Data Wiring: nr:: + Signs Ballasts No.of Devices or Equivalent i Telecommunications Wiring: E ':o. ; massage Bathtubs 1No• of Motors Total HP No.of t'evices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. -„e of Electrical Work: (When required by municipal policy.) . 12i ' _ Inspections to be requested in accordance with MEC Rule 10, and upon completion. t E G E: Unless waived by the owner,no permit for the performance of electrical work may issue unless provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The ..-.1 certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. C E: INSURANCE X BOND ❑ OTHER E (Specify:) 1 ce r,, ,: . iier the pains stud penalties of perjury,that the information on this application is true and complete. 17 , ; '4 Wellingto : R Soares, Inc. �' 1 LIC.NO.: 21075A Lice_ Wellington R Soares Signature CV) ' C LIC.NO.: 11376E ' ''' 1`3d"lfrged<:" Ili ficcrun e15, Iryareinis, MA Bus.Tel.No.: 508 778 5936 Alt.Tel.No.: 774 836 5877 47. S. 57-61,security work requires Department of Public Safety"S"License: Lic.No. SUR ,NCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally rFo r ° taw. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Telephone No. PERMIT FEE: $ 1 6,