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HomeMy WebLinkAboutBLDE-23-002112 ,ku ......E Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-002112 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked APPLICATION FOR PERMIT TO PERFO 1/RM ELECTRICA L 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) City or Town of: YARMOUTH Date:the Inspector of Wires: 2 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 49 SALT BOX RD Owner or Tenant RYAN MARK S Owner's Address RYAN KAREN D,49 SALT BOX RD, SOUTH YARMOUTH, MA 02664 Telephone No. 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 New Service Ampsglo.of Meters Volts Overhead 0 Undgrd 0 4,11!0) terNumber of Feeders and Ampacitys ram : Location and Nature of Proposed Electrical Work: Install EV char.er tit ra L Completion o/the following `R 47 ..:3f%' ii1; z ,r of Wi, No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Air Ai o.l No.of Luminaire Outlets a, i s. ginNitti ,`�. No.of Hot Tubs Generators s i No.of Luminaires Swimming Pool Above. ❑ In- ❑ No.of Emergency Lighting grnd grnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiatine Devices No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ita : -- t.t, VI)_Al•rti , D, No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Ballasts Siena Data Wiring: No.Hydromassage No.of Devices or Equivalent g No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wire 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: John B Gill Licensee: John B Gill Signature LI NO.: 20846 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 11 FRANKLIN ST, SALEM MA 019702503 *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: $50.00 RECEIVED :, g OCT 19 t t iw tt opt sport sots of, r;.c.,wiue Permit No. -�'�-,gyp BUILDING DEZPARTM �cyand Fee n, By SOAR)OEEIRE. " EV NTIGN REGULATIONS R:ev. 1/0 ,„ (leave . .,,, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. All work to be:performed in accordance with the Marrschusetta Electrical Code(MEC),527 CMR)2.00 ,, (PLEASE PRINT IN INK OR TYPE ALL INPORM4 71OA) Date: /e /r/aa� City or Town of: `r ,nou-4-h To the I 6 tor of Wires; By this application the undersigned gives notice of his or her intention to perform the electrical'work described below. ` Location(Street&Number) el .4G1 6os /De,( see, N, Owner or Tenant /T'm R.�!�/ . Telephone No. d a-2 7 Owner's Address . • S A»�. 1,Is this permit in conjunction with a building permit? Yes No !;: (Check ; . / � Appropriate Box) Purpose of Building i2e i4t-t,a ,. Utility Authorization No. Al t Existing Service 2OO Amps /3v / yo Volts Over ' Uud'' grd❑ Na of Meters J New Service , Amps / Volts Overhead 0 Undgrd 0 No.of Meters 1 Number of Feeders and Ampacity l, Location and Nature of Proposed Electrical Worrk: r2kf,Q.// 4 N)yrl Al'ye,' `V 50® .c, >Sie. ` Completion of tItefaiowinglable maybe waived by the or of Wires. t#T No.of Recessed Lum noires No.ofCelL-Seep.(Paddle)Fans Tr ot Transformers KVAA No.of Luminaire Outlets No.of Hot Tubs Generators KVA k No.of Lnminsires SwimmingPeel i Ia.a tymergeracy i, dog } © ❑ Blirt#erY Units . .:".,1 No.of Receptacle Outlets No.of Oil Burners , FIRE ALARMS No.of Zones r No.of Switches No.of I liners eta.of Detection and Initiating Devices IQ No.-of Ranges No.of Air Coud. Tonns� No.of Alerting Devices No.of Waste Disposers Heat Pump bomber Tons `I(W �No.of Self-Contained TotaV. ". """ - "" DetectioNAle Devices No.oe Dbhwrashers Space/Area Heating KW L Ocal CICO n 0 other : Na.of Drger* Heating Appliance* Security : No.of;makes or Equivalent No.of Waateerere "No.of No.of 'Daus Signs Ballasts ' � `' Nu of I?Eevi4�eai►or : , , : ..t No.Hydromassage Bathtubs No.of.Motors. Tota HP 'Taec°1 mmann3caifons ' f 1 Na of Devices ar Est' z. OTHER: r, Attach additional detail ifdesired or at requ 2d by the&specter of Wires:. Estimated Value of Electrical Work: /, ODO (When required by municipal policy.) Work to Start /01o�r/zZ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 (',a_ BOND 0 OTHER 0 (Specify.) I cerx*„ander the pa and penakles ofpednyp,that the information on t klb application is.trwe and complete. FIRM NAME: _ .i not.`.l0 i►t ea,I ...5 < / . LIC.NM: . -4z. f 1' Licensee: 41An, & 6!// sign: re ,�j y LIC.NO Pj$''6 A (If applicable,enter"exe+ pt,jn the license number line, :Bits,Tel.No.: f 3-5.. 7- .A37 Address: fa / Nt$� l'1 bi l /Ja f i'/�' 'Per M.G.L.c. 147,s.'S7.6lwork. i / Alt.TeL Na:`1 G Gr�pg' !security requl Department of Public Safety:"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hove the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)Q owner Downer's agent. Owner/Agent Signature Telephone No. `PERMIT FEE:.,S