HomeMy WebLinkAboutBLDE-23-004042 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-004042
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:1/23/2023
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) 26 ANASTASIA RD
Owner or Tenant GALLAGHER AMY T Telephone No.
Owner's Address GALLAGHER JAMES P, 210 MAIN ST,WINTHROP, MA 02152
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 furnace.
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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water 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 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: Joseph W Silva
Licensee: Joseph W Silva Signature LIC.NO.: 9147
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 30 BOURNE HAY RD, SANDWICH MA 025632761 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: $50.00
I(7 4Oq (1 1 ). L1Cl'irA l I, 0,7
Cotrunonweatth o//yladdaclzueet Official Use Only
=i=5t tnent Permit No.
=�%l_= e/nar o��ire Serviced
`=1'f=g.1 Occupancy and Fee Checked
„� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: 1 ti - -S
City or Town of: fir?-i n, r i# To the Inspector of Wires:
By this application the undersignedgives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) %ZI,
�Ir �n�'�ISin s it
-, Owner or Tenant ,j r .i C 4.4 i 1 ii / Telephone No.
Owner's Address �`�-
E Is this permit in conjunction with a building permit? Yes U No E (Check Appropriate Box)
tl
Purpose of Building /rz=-'-7/A -_
v Utility Authorization No.
AExisting Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters
to
J New Service Amps / Volts Overhead 1 1 Undgrd n No.of Meters
Number of Feeders and Ampacity
1—
Location and Nature of Proposed Electrical Work: --4`n,'.VLc"7 Xti=c.oc .,14(ti/7 ` ;'
ri
Completion of the followin•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. grad. Battery Units _
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners I No.of-Detection and
I Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number fTons KW INo.ofSelf-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW ;Local❑ Municipal
Connection ❑ O�er
No.of Dryers Heating Appliances KW eCNo.ofystems:*
Devices or Equivalent
No.of Water No.of No.of
KW Ballasts Data Wiring:
Heaters
Signs No.of Devices or Equivalent
No.Hydramassage 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: -.2,." "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 covers e is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 2--BOND
0 OTHER ❑ (Specify:) �i213'1/t1E/P—G ��S ;�';
I cert fy,under the pains and penalties ofperjury,that the information on this application is true and compere.
FIRM NAME: /LA/A F L f 2IC...
Qh S t� 'f'� Si afar LIC.NO.:4--?`77
Licensee: .:_.)t5st gn LIC.NO.:. ZtG 4-7
of applicable,enter "exempt"in the license number line.
Address:( D Boo,--- - �1,9-st ,2r]' ,Q,JjrJrCd Bus.Tel.No.:�&—`f2-k''le)
/1?9 02' �s Alt.Tel.No. U 3t /-'/3/I
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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)0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$