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HomeMy WebLinkAboutBLDE-23-002874 r' Commonwealth of Official Use Only INI ti Massachusetts Permit No. BLDE-23-002874 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:11/23/2022 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) 6 HEMEON DR REAR Owner or Tenant CARVALHO SIRLENE Telephone No. Owner's Address 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: Replacement split A/C 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. grnd. 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. 1 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 ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No No.of Devices or Equivalent HeatersWater 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 ofperjury,that the information on this application is true and complete. FIRM NAME: JESSE R LING Licensee: Jesse R Ling Signature LIC.NO.: 15646 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: PO BOX 1200, WEST CHATHAM MA 026691200 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. I PERMIT FEE: $50.00 I ( ommoru ea& of///a�aachusefts Official Use Only 0 , 2eioartiment oil.. irc Serviced Permit No. - ,, BOARD OF FIRE PREVENTION REGULATIONS V cv. l/0 and Fee Checked ev I/07] (leave blank) -- APPLICATION FOR°PERMIT TO PERFORM ELECTRICAL WORKAll work to be performed in accordance with the Massachusetts Electrical Code C),527 C2 00 (PLEASE PRINT IN INK OR TYPE ALL INFOPJVI4TION) Date: City or Tows of: VARMOUTH s . By this application the Eundersigned gives notice of his or her intention to To £he Inspector of Wires: perform the electrical work described below. • Location(Street&Number) Owner or Tenant f o 61 3 Owner's Address . TeIephone No. ® Iz hF permit in conjunction th a binding permit? Yes T LLB d' N Pt .se of Building �- o (Check Appropriate Box) c� Utility Authorization No. E �oVtis ng Service Amps Q p / Volts Overhead Undgrd co %�.ervice _ s .No, of Meters LLl Amps / Volts Overhead ror 40n -r of Feeders and Ampacity Undgrd ❑ No,of Meters Ili0r CD CD and Nature of Proposed Electrical Work:A.co m ! Li., ` �' ti �No.of Recessed • Aii Completion of ollawino table m- Luminaires be waived b the Inspector of Wires. !No.of Cell.-Susp.(paddle)Fans No.of Total INo.of Luminaire Ou Transforrne KVA INo.of Hot Tubs No.• of LuminairesAboveGen ors KVA Swimming Pool �d e LI In- ate Units ncy a ctng No.of Receptacle Outlets 'mod' Battery Units of Oil Burners FIRE A.LARhIS No.of Zones No.of Switches INo.of Ga :to Hers o.of Detection and iggillIMMINo.of Ranges IaitiatinQ Devices Na. of Air Co.. otal No.of Waste Disposers ji� Tons No.of Alerting Devices IHeatPu .• Numbe _Tons KW No.of elf-Contained T. ais. `- !Detection/Alert z!!Devices Na. of Dishwashers S'- NOM L 0 Municipal No. of Dryers 'Heating Appliances Connection ❑ Other No,of ater KW Security S stems:* No. of r No.of Devices or E.uivalent Heaters IC O. o Siffns Ballasts Data Wiring; � No.Hydromassage Bathn:bs No.of Devices or E.uivaIent No.of Motors Total HP Tele emmuniations Wiring: OTHER: No.of Devices or E.uivalent Estimated Value of Electrical Attach additional detail if desire trical Work: d oli as required by the Inspector of Wires Work to Start: t���Z � (When required by municipal policy.) INSURANCE to S Inspections to be requested in accordance with MEC Rule 10,and upon completion. CTE COVERAGE: Unless waived by the owner,no permit for the erfo 3.) the licensee provides proof of liability insurance including"completed operation"coverage or its beat work ui undersigned certifies that such coverage ' may issue unless CHECK ONE: INSURANCE in force,and has exhibited proof of same to the permit issuing officee . Lrvalent, The I certify, under the pains and penalties BOIv� ❑ OTHER ❑ (Specify:) P ties operjury, � �') FIRM NAME: fthat the mfgrnz¢tfon on this application is true and complete 3 �^i i� - �Zt>Lo, (, Licensee: ,, LIC.NO.: (S(y � (If applicable enter empt in the license number tine) Signature i Address: LIC.NO.: 3€0(.3 Q, ! "Per M.G.L. c. 147,S.57-61,security©rorequir, C.-A it\of Public Spa fC o�CP Bus.Tel.No.:So • 3 _ 1 c. No. OWNER'S INSURANCE WAIVER; I Alt.Tef.No.: OWNSrequired by law. am aware that the Licensee does not have the liability insurance covera`�- S Owner/Agent By my signature below, I hereby waive this requirement I am the(check one [] Signature g-normally owner ❑owner's a•ent�' TeIephone No. PERMIT FEE: S