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Home My WebLink AboutBLDE-23-001378 _ {o Commonwealth of Official Use Only Permit No. BLDE-23-001378 4E 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:9/15/2022 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. • .// D Location(Street&Number) 16 ELDRIDGE RD —`'f Oc Owner or Tenant SIELAND FREDERICK Telephone No. Owner's Address SIELAND KARIN, 184 MOUNTAIN RD, PLEASANTVILLE, NY 10570 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 0 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: Finish inspection for expired permit. 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 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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 ❑ 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 ❑ (Specify:) !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: $50.00 RECEIVED /� aa// yyyy�� / ;SEP 14 2022' .. CommonawaaUh o////aseacAaaatld s..Cid Uri'_ w By. ARTME T ;y,+�a c^/A cc77 [[i� Permit No. - ar'- .)epartment of. ire Serviced P cy J/�� ]I BOARD OF FIRE PREVENTION REGULATIONS Occu 7 and Fee e;ke s Permit Icaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Coda(MEC), 27 CMR 12 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: v,G00 le/ 20 22. City or Town of: YARMOUTH To the Inspector of Wir : By this application the undersigned gives notice of hjs or her intentio ,rform the electrical work described below. Location(Street&Number) /6 6—/ /1,n L /!l✓Cy_./ ,{ Owner or Tenant /Cie c 5,�4 d J Telephone No. 974/400D$lS X� Owner's Address /6 /�Oi cad .�, /f d 5,,,,se/e ,.., /-' /FM ()266 41 Is this permit in conjunctionti with a buuil�ng permit? Yes No ❑ (Check Appropriate Box) Purpose of Building//tom•!Iv' /jy�r r)„.- c Utility Authorization No. Existing Service t/ Amps ILY_.'/ Volts Overhead[iy Uudgrd❑ No.of Meters Z3/4>4". New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /L r otfriEl-/ ,464/j , s, s, Completion of the following,table m be waived by the I torof ai'res. W No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans Tr n� "'� Transformers KVA No.of Lum(nalre Outlets No.of Hot Tubs Generators KVA 4' No.of Luminaires ' • Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets I t.F No.of OR Burner FIRE ALARMS No.of Zones T No.of Switches No,of Gas Burners 'No.of Detection and Initiating Devices 11.! No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste DisposersHeat Pump Number Toms KW No.of Self-Contained Totals:I� -__. _.....�"" ' "�'- Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑other Co 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 R No.of Devices or Equivalent No.Aydromeaaage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: F4N /ter4A(✓ST "t i Attach additional detail if desired,or as required by the Inspector of{Wires. Estimated Velue,gf Electrical Work:`/ GZ (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 0 BOND❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: (ifappplicable,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: Lic.No. OWNER'S INSURANCE R: I am a that the Licensee does not have the liability insurance coverage normally required by law.By m ,I y waive this requirement. 1 am the(check one)❑owner ❑owner's agent. Signature Telephone No.,4/41042 r '7 PERMIT FEE:$ J