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Home My WebLink AboutBLDE-23-001783 Commonwealth of Official Use Only • Permit No. BLDE-23 001783 alint k '( Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:10/4/2022 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) 15 JEFFERSON AVE Owner or Tenant OLSON JOHNATHAN E Telephone No. Owner's Address LARRIMORE KIMBERLY, 15 JEFFERSON AVE,WEST YARMOUTH, MA 02673 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: Remodel kitchen Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 No.of Ceil.-Susp.(Paddle)Fans 1 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 10 No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges 1 No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 5 Totals: Detection/Alerting Devices No.of Dishwashers 1 Space/Area Heating KW Local ❑ Municipal Connection 0 Other: No.of Dryers 1 Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water 1 KW No.of No.of Ballasts Data Wiring: Heaters Signs 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: 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 ❑ 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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: $75.00 OCT 04 2!.;41 0' y�j / 1 Commonwaa&al///adeachadsffd O i e Only' cc'� cc77 nn Permit No. /7 6 3 BUILDING D r r M.�, h T ..CJsparinuni oi.. irs Jsrvicse a.` : BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [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 TYPE ALL INFORMATION) Date: 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) l ti Owner or Tenant j,,,`,., W /i,.v Telephone No. '77 lCq6 Owner's Address �.c.i,_ . ,4,, Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building /' `,,,,, /,_, Gr,,L /Z 4 `, Utility Authorization No. Existing Service CcAmps; / / Volts Overhead Eig Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: •� //%� ; k (/ u, r�1 `t Completion of the following table m be waived by the Inspector of Wires. U.) No.of Recessed Luminaires /C No.of Ceil:Susp.(Paddle)Fans No.off Total ( Transformers KVA /Cl Z1 No.of Luminaire Outlets r; No.of Hot Tubs 7 Generators v KVA t' No.of Luminaires �- Swimming Pool Above In- 'No.of Emergency Lighting :' rnd. Q grnd. ❑ Battery Units No.of Receptacle Outlets /c No.of Oil Burners FIRE ALARMS JNo.of Zones 1 No.of Switches / No.of Gas Burners i No.of Detection and No.of Ran Total es Initiating Devices g No.of Mr Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I�mber. Tons i KW No.of Self-Contained - Totals:l.........._.._ } No.of Dishwashers Detection/AlertinzDevices Space/Area Heating KW V Local Municipal Connection ❑ Other No.of Dryers ( Heating Appliances KW Security Systems:* No.of Water , No.of Na.of No.of Devices or Equivalent Heaters Signs /' Ballasts 7 Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs r . No.of Motors Total HP No. Wiring: OTHER: No.of Devices or Equivalent 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: 1c' '� /z c z,-.. 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. FIRM NAME: Licensee: LIC.NO.: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Address: Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: AILLic.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 owner owner's a ent. Owner/Agent /� Signature �( Y-C -� Telephone No.4q—%JI //g� PERMIT FEE:$ 7,