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HomeMy WebLinkAboutBLDE-23-002440 p Commonwealth of Official Use Only „t to Massachusetts Permit No. BLDE-23-002440 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:11/3/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives nonce of his or her intention to perform the electrical work described below. Location(Street&Number) 497 NORTH DENNIS RD Owner or Tenant ONEIL DENNIS P Telephone No. Owner's Address P O BOX 106,YARMOUTH PORT,MA 02675 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 ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 10 X 10 Addition Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and Initiation Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number bolts KW No.of Self-Contained Totals; Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: Steven D Robbins Licensee: Steven D Robbins Signature LIC.NO.: 13945 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:38 CHURCH ST,HARWICH MA 026452210 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:$75.00 (I L 62 owe., pe. tag NM a/LB/iz DECEIVED N' OVO 2 = -,...., ___ __ ,_7.f' C01)LHio7LwsaLLK o/ma ac f Official Use Only ryry�� Permit No. Z3' -Z,C4C-lb BUILDING DE'', .0k1= �Uaparfinaat o��ira Serviced '# ' Occupancy and Fee Checked By. BOARD OF ARE PREVENTION REGULATIONS y'`� r [Rev. 1/07J (leave blank) APPLICATION FOR= PERMIT TO PERFORM All work to be performed in accordance with the MassachusettsELECTRICAL WORK Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i j ; City or Town of: YARMOUTH To the Inspecto of Wires: By this application the widersigned gives notice of his or her intention to perform the electrical work described below. • Location (Street & Number) Li g 7 Al YN , 5 R•J Owner or Tenant ,76 ) d Ni L. Telephone No. o� 0-1 — �l� ( _ e1Sv Owner's Address Is this permit in conjunction with a building permit? Yes X No . . . E (Check Appropriate Box) Purpose of Building O1 1=1 L� Jt (e.k ,© Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd�' ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires elNo. 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. arnd. Battery Units No. of Receptacle Outlets I O No. of Oil Burners FIRE ALARMS No, of Zones No. of Switches 3 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No.. TonsAlerting Devices of Air Cond. Total No. of Devi -No. of Waste Disposers , Heat Pump] Number No. of Self-Contained Totals: i fTonsHKW `-_Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Oth �' No. of Dryers Heating Appliances KW Security Systems:* No. of Water No, of No. of Devices or Equivalent 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 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,INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance f and upon completion. the licensee provides proof of liability insurance including "completed operation" coverage o electrical work may issue unless itundersigned certifies that such coverage is in force, and has exhibitedproof ofor substantial equivalent. The CHECK ONE: INSURANCE El BOND same to the permit issuing office.71 I certc�y, under the pains and enalttes v 0 OTHER � (SpeC1fy') L It4gf�.-� FIRM NAME: p f perjury, that the information on this application is true and complete. Licensee: LIC. NO.: 3� .� Signature LIC. NO.: (Ifapplicable, enter "exempt"in the lice a num er line.) Address: �, � ex. . f.J'~G Y 5 Bus. Tel. No.: D ' �- C1.0 „� *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safe "S„ Alt. Tel. No.: - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the License: Lic. No. S required by law. By my signature below, I hereby waive this requirement. 1 am the (check insurance coverage normally 7 Owner/Agent ( k one ❑ owner ❑ owner's a:ent. Signature Telephone No. PERMIT FE • :Shy 'vi'