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HomeMy WebLinkAboutBLDE-23-001815 a Commonwealth of Official Use Only fa, Massachusetts Permit No. BLDE-23-001815 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.1/071 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:10/5/2022 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) 32 CAPT BEARSE RD Owner or Tenant EVENS GENE Telephone No. Owner's Address j/ Is this permit in conjunction with a building permit? Yes 0 No 0 (Check AJnI�rtipriate Purpose of Building Utility Authorization No. . N « ..f ! 7 Existing Service Amps Volts Overhead 0 Undgrd 0 f e elQflkl to/s.C'�,I`E.-f New Service Amps Volts Overhead 0 Undgrd 0 '°-',-1 orli'LMete 4 .' 03 Number of Feeders and Ampacity ` J Location and Nature of Proposed Electrical Work: Demo basement wiring. Completion of the.following table may be waiveda/tltts.]ni2tstor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of >,/ idtal 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. 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 0 Municipal 0 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: 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: $200.00 RECEIVED OCT 05 202ra aatfh of tt/astaciiadaiie Official Use Oni �n -1 d(S DING DL=f-ARTM N 4o in Permit No.rvicaa Occupancy and Fee Checked BDARC REVENTION REGULATIONS [Rev.I/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) rL Owner or Tenant EiR/',47124 ,,/ Telepho No. t(- ) ��N-a� ' Oweer's Address (j� Aim � � p�tJt.�4Ol? �sf'pt< /�• /351/ • Is this permit In conjunction with a building permit? Yes © No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: V ttfQY.,\2+'NV ee Completion of the followiee table m be waived by the ins ector of Wires. t. No.of Recessed Luminaires No.of Cell:Seep.(Paddle)Fans No.of 7 oral Transformers KVA t No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No. Emergency Lighting grad. grnd. Battery Units No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and { _ Initiating Devices Ill No.of Ranges No.of Mr Cond. Total No.of Alerting Des ices Tons No.of Waste Disposers Totals: Pump Number Tons KW No.of Self-Container Totals: - "'-"'" Detection/Alerting Devices No.of Dtsbwashers Space/Area Heating KW Local❑Muninnectcipalion ❑other Co No.of Dryers Heating Appliances KW Security Systems:• No.of Devices or Equivalent No.of Water No.of No.ofKW Data Wiring: Heaters Sins Ballasts g Na of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin : 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: 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❑ OTHER❑ (Specify:) I certify,under the pains and penalties of pedury,that the Information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (ifapplicable,enter"exempt"in the license number line.) Bus.TeL No: Address: Alt.Tel.No.: *Per M.G.L.c.147,s.57-6I,security work requires Department of Public Safety"S"License: Lic.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 agent. Owner/Agent t Signature ,"vim (jP r d-_ Telephone No. PERMIT FEE:$ 0.1101 "�t • • •