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Home My WebLink AboutBLDE-23-005530 Commonwealth of Official Use Only E.` 6\. Massachusetts Permit No. BLDE-23-005530 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:4/5/2023 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) 7 CRESCENT CT Owner or Tenant GARDINER ROY L Telephone No. Owner's Address DORAN CATHERINE MARTINA, 64 HIGH RD ESSEX, BUCKHURST HILL, ES,00 IG9 5RW 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 ❑ 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: Septic pump&alarm. 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 No.of Detection and 1 Initiatine Devices C. 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 47V/ No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or EuuivalentIlk No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Euuivalent No.Hydromassage Bathtubs No.of Motors 1 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: MICHAEL F SIMON IS 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 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 & �3 q(e) 72, W2 RECEIVED • - _,�'_1 l�om+nonweaE� ///aeaac�eu�lfa Official Use 1 iii * 'r c� cc77 Permit No. �� F3UILDI1V�G D �" C. >g i eLJ.pa.im.rd o/.}ira&i'vwae "w Occupancy and Fee Checked By _ — .,.,,-' OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) 1 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: 7'/y/2 L City or Town of: To the Inspector of Wires: l C� By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 7 1?72 --- S c --_rz i C`m v; i Owner or Tenant 1 c y 6':�- g/1k2 r Telephone No. Owner's Address l Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) ., Purpose of Building S/.?fly 71-i>f/ D,:.vr -- Utility Authorization No. v. Existing Service Amps / Volts Overhead n Undgrd E No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity V\ Location and Nature of Proposed Electrical Work: lt//.z._e S'.ej-�7�c-- j�,:.. ;' Completion of the followinKtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp. Fans No.of Total (Paddle)) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 4 No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units ` No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. InDete and Initiatinnggon Devices Total 1!f No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers *Beat Pump Number Tons KW `No.of SeWf-Contained _ p° Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other, Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent , No.of Water , *No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of MotorsTotal HP TelecommunicationsofDeicest Tiring: / ,� No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of E tri a1 Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE 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 cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) — /-e-/'= I certify,under the pains and penalties of perju7,that the information on this application is true and complete. FIR:.i NAME: S/•'-2,0, -,,5 P 2,c .32 c- z LIC.NO.: A/ 2,S� ,, Licensee:/ - -/ L i,.fr'/c)<4 r 5 Signature G.i-% IC.NO.:.-31) 3s- (If applicable,enter"exempt"in the license nymber line.) Bus.Tel No.: Address: J C' /�0 X //cg/ . i> fJ/ / - L'.) / Alt.Tel.No.: C Z'e"K 66 f 7 *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:$3-6 ,G ESOS r.i,i'IA