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HomeMy WebLinkAboutBLDE-23-000452 ..... Commonwealth of Official Use Only - 4:,, 1 Massachusetts Permit No. BLDE-23-000452 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:7/28/2022 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) 259 OLD MAIN ST Owner or Tenant Kerni Power Telephone No. Owner's Address 259 OLD MAIN ST, SOUTH YARMOUTH, MA 02664 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 M qii New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters' ".� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: In-ground pool. 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 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abovend. ❑ nr ❑ No.of Emergency Lighting Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Ballasts Data Wiring: 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 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: LAWRENCE R BROWN Licensee: Lawrence R Brown Signature LIC.NO.: 30708 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 LIMERICK CT, CENTERVILLE MA 026322713 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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. I PERMIT FEE: $85.00 1 J 1* '-1 8(5(1v RECEIVED _ oin on ealth of ///aJiachwett� Official Use Only ' f JUL 7 202 (. 2 II Permit No. ( 5.11( 14i e a.r rant o ire .'ervice.i � u1t 1IMf ' IF�'fz REVENTION REGULATIONS Occupancy and Fee Checked 7- e Y� __,._., _. -- - — [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: �/a/y ,2 7 ,p�✓',„ City or Town of:y /1UR To the Inspector of Wires: By this application the undersigned gives notice of his or her inter' ion to perform the electrical work described below. _--- y Location(Street&Numberr,)^ � °L P &I/ Aewto�717 Owner or Tenant L�7 R/ KC/a-4 Telephone No:50, ��1;2 37,15 Owner's Address ,51 "—_ Is this permit in conjunction with !k.,a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building till fv Utility Authorization No. �U/ �b Volts Overhead Q- �ndgrd ❑ No.of Meters Existing Service fig) Amps /. New Service Amps / Volts / Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity '3 (A) f t Location and Nature of Proposed Electrical Work: r el) -z- t J ? L- 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 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting grnd. erns. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices ToNo. of Ranges No.of Air Cond. Ton No.of Alerting Devices No. of Waste Disposers Heat Pump L Numl?et_i_ Tons Toni _KW___ No.of Self-Contained Totals:r Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW No.of Data Wiring Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 4 r t l h Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 7 (When required by municipal Work to Start: / 11-, 2—Inspections tb be requested in accordance with MEC ulel1y)INSURANCE COVERAGE: Unless waived by the owner,no (o and upon completion. permit for the the licensee provides proof of liability insurance includingperformance of electrical work may issue unless undersigned certifies that such overage is in force,and has exhibited proof of same to the pen"coveragerrmit issuingits sutial offiiceuivalent.The CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) !terrify, under the pains and e j 1 ' of pe rry� the information on this applicatipn is true and complete. FIRM N '69jee' tll%�/%trl.�' Licensee: Signature i LIC.NO.: 3 4/©' LIC. NO.: (If applicable,_enter'e empt"in the license number line. Address: ';('} / j� � ,� e � � ��� � Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety "S"License: Aft TeloN� ���� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor 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/Agent ) 0 owner's agent. Signature Telephone No. PERMIT FEE: $