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Home My WebLink AboutBLDE-23-002639 Commonwealth of4\)---1—; Official Use Only Massachusetts Permit No. BLDE-23-002639 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rRev.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:11/14/2022 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) 8 SETUCKET RD Owner or Tenant PONS ANNA R Telephone No. Owner's Address 8 SETUCKET RD,YARMOUTH PORT,MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate BoxA/ �y p Purpose of Building Utility Authorization No. 11130078 4) - Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service,bedroom&bathroom.Wire addition. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddlc)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 jnitiatine 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KM Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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. r Q ny CHECK ONE:INSURANCE 0 BOND CI OTHER ❑ (Specify:) g-g$� C:J 6 f3 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MICHAEL F SIMONIS Licensee: Michael F Simonis Signature LIC.NO.: 16862 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 1488,EAST DENNIS MA 026411488 Alt.Tel.No.: *Per M.G.L.c.147,s.57-61,security work requires Departnteiit 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) ❑owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$180.00 '4f I4111'274e (I -t t' DP N4 kai � uiJ RovGH 6ADAtro„)Olt_I2fz/2 1-1 ic(23 .- RECEIVED `44' NOV 10 2022 ,nry aitk o{ii/aeaac/taealle Official Use Only 1J • . f/ c� n Permit No. ': �'�1 1 t,._- s,• nl o/Jir,Serviced !� -MG DEPARTME_ Occupancy and Fee Checked j� 1•-•••-:': -i PREVENTION REGULATIONS [Rev, lro7] (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: i,/l/,.2._ City or Town of: ,¢/LRtry� To the Inspector of Wires: By this application the undersi ed gives notice of his or her intention to perform the electrical work described below. LJ Location(Street&Number) Q ,c-e-1-r/ -e-5L- /2e Owner or Tenant 4i'I/7,o- 7p S Telephone No. P. Owner's Address S� '-e lIs this permit in conjunction with a Iding permit? Yes No ❑ (Check Appropriate Box) 1 Purpose of Building5� ,C �� u-; Utility Authorization No. ///3 O O 7? Lir i Existing Service/ Amps /_24 /.-?y2Volts Overhead Q' Undgrd❑ No.of Meters / p No Service ,2049 Amps„/„.7D I?940 Volts Overhead Er' Undgrd ❑ No.of Meters / Number of Feeders and Ampacity 4,/p/ S -e 4-, Location and Nature of Proposed Electrical Work: ,ruz- riee /..")2prrr,lC /-2. .1S.e.,/ r-- '�,L-A // r// - ,e mo d�v �� l i o-"i 4-7Bvf Gi 7, %i•7is L, ( 4,4"i rt-- i'oom_) egg Completion of the followingtable may be waived by the Insyector of Wires. ,A otal 1 P (Paddle)No.of Recessed Luminaires No.of Ceil.-Sus . Fans No.Transformers KVA 01 No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- No.or Emergency Lighting No.of Luminaires Swimming Pool grnd. r-i grnd. ❑ Battery Units E No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices rs Heat Pump Number„Ton; KW No.of Self-Contained No.of Waste Dispose Totals: '� Detection/Alerting Devices — No. of Dishwashers Space/Area Heating KW Local 0 Connneetion 0 Other No.of Dryers Heating Security Systems:*Appliances KW No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivagglent No.Hydromassage Bathtubs No.of Motors Total HP TelNo.of Devices or Eqmunications uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of E ectrical Work: (When required by municipal policy.) Work to Start: ® Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE GE: 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 0 (Specify:) �/tit4"`el-€,c.0 I certify,under the pains and penalties of pedstry,that the inji2. don or this application is true and complete. FIR I NAME: ,S'«o-ie--/s ZJ. lr hC LIC.NO.: ,¢-/(per/.,2.- Licensee: Signature e. 1 5:L' o-il/SLIC.NO.;,�30,..3-3g 7 (If applica enter"exempt"in the license number line.) Bus.TeL No.:5� .6�( Address: �K //Veg - De's7,2P s it.l.71t �• .ffl Alt.TeL No.: *Per M.G.L.c. 147,s.57-61,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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$/ ..e76 e