The URL can be used to link to this page

Home My WebLink AboutBLDE-21-006534 .--tr, . Commonwealth of Official Use Only Permit No. BLDE-21-006534 4111� Massachusetts 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:5/11/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perto the electnc work des ribed below. Location(Street&Number) 16 ICE HOUSE RD HYW V Owner or Tenant Vii0L-PeehttltRittRD Telephone No. Owner's Address , Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appiate Boxy/ Purpose of Building Utility Authorization No. w Existing Service Amps Volts Overhead 0 Undgrd 04% 1.of ray # • lb New Service Amps Volts Overhead 0 Undgrd 0 Number of Feeders and Ampacity Location and Nature of Pro posed Electrical Work: Kitchen&livingroom renovations. to �PO 84p:" Completion of the following table may be wai t , of Wires. No.of Recessed Luminaires 8 No.of Ceil:Susp.(Paddle)Fans No.of Transformers No.of Luminaire Outlets No.of Hot Tubs Generators A No.of Luminaires Swimming Pool Above ❑ in- I: No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 6 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 1 Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Securiq Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts 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 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 P-E)1.)Ceet f 2—f ..._ Commonwealth of r//aeeac�effd `Official/ �Usse Only , !"A / /c7 Permit No. e2 - 4-1 -.ar,y. apartment a ..tin Serviced '��;7 y Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.vo71 (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 -21 To the Inspecto of Wiles: By this application the undersigned gives notice of his or her intention to perform the 5ectrical work described below. Location(Street&Number)�� Owner or Tenant �c �PQ Telephone No.t6-71)k, 9 94 Owner's Address '50 rYln h Is this permit in conJunctio with a building permit? Yes Rcl No ❑ (Check Appropriate Box) Purpose ofc Building tI.4(d all,T!(L' Utility Authorization No. Existing Service OD 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: %1.47„f•)e✓' {Lic.. //_lam f,-,.1 _. vy Completion of thefollowingtable my,be waived by the Inspector of Wires. it No.of Recessed Luminaires Q No.of Ceil:Sosp.(Paddle)Fans No.of 1 otal t! Transformers KVA <:t No.of Luminaire Outlets No.of Hot Tubs K1 Generators KVA .i- No.of Luminaires Swimming Pool grAbove ❑ In- No.of Emergency Lighting and. grnd. ❑ Battery Units No.of Receptacle Outlets I No.of Oil Burners FiRE ALARMS INo.of Zones No.of Switches II_ No.of Gas Burners "No.of Detection and t G.�/ Initiating Devices No.of Ranges No.of Air Cond. TToon 1 No.of Alerting Devices No.of Waste Disposers Heat Pump Number 'Con; , K_W No.of Self-Contained Totals:I .._...`..... ....... ............... 1 � Detection/Alerting�Devices No.of Dishwashers / Space/Area Heating KW Local ElMuniclpal Connection ❑Mer 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: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:q )COO (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 ofperfury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature t/fapplicable.enter"exempt'in the license number line.) Tel. NO.: Address: Bus.Tel.No.. "Per M.G.C.c.147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lie,No. OWNER'S INSURANCE WAIVER: i urn aware that the Licensee does sot have the liability insurance coverage normally required by law. By my signature below;1 hereby waive this requirement. 1 am the(check one owner owner's agent. Owner/Agent�/ ffn �re rnc�/� K v it 4 Telephone No., a3L PERMIT FEE:$ 7�� Slgnatt