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HomeMy WebLinkAboutBLDE-22-004825 Commonwealth of Official Use Only I.. , Massachusetts Permit No. BLDE-22-004825 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:3/2/2022 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) 100 POMPANO RD Owner or Tenant Duneau Joseph Telephone No. Owner's Address THE 100 POMPANO RD RLTY TRUST, 100 POMPANO RD,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 1 ,4Meters New Service Amps Volts Overhead 0 Undgrd 0 Wb°af' ers Number of Feeders and Ampacity 411% Location and Nature of Proposed Electrical Work: Permit&inspections for work done in apartment i - '0 Completion of the following tab - . . ait� nspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of �O otal Transformers No.of Luminaire Outlets No.of Hot Tubs Generators VA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency n grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS Opnes No.of Switches No.of Gas Burners No.of Detection and Initiatme Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices 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 0 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 ❑ 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 LW.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: $250.00 RECEIVED �� MAR 012022 `/'� yyy�jj _. l�o o ea& of//lasaac<nusal Official Use Only Li== j-='tILDING DEPARTMENT cc-77� n = �1- =.- f _fire) Permit No. &ZZ -"f65 o ervice9 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 2V—,------ ' ,tRev. 1/07] (leave blank) A D DI In Artnti r-/•Nr, 2...2- -._ - -- -• - . ..... . ..ax 2 L�2 yin I I I V I ERRr-ukm tLtU I KIUAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INS OR TYPE ALL INFORMATION) Date: City or Town of: YAR1VIOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the e ectrical work described below. Location (Street&Number) V00 VZINN( 'sr) RA , `1 ,� n , �i, ¶p� _. Owner or Tenant ka ti�u� -- JZQ.,IU\ ��-'u 71�Telephone No: Owner's Address ' n��� ,�0 ,p,� ) �J`f j f M VI t © �pS- Is this permit in conjunction with a building permit? Yes No �� ` ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Llndgrd E No. of Meters New Service Amps / Volts Overhead❑ Undgrd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: orv(kks,„\okt - r 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 Lmergency Lighting ornd. arnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devices - No.of Ranges No_ of Air Cond. Ton No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: _ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Municipal L0�❑ Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No. of WaterNo.of Devices or Equivalent No. of Heaters KWNo. 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: (When required by municipal policy.) Work to Start: 6 pections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C ERA : n es waived by the owner,no permit for the performance ct the licensee provides proof of liability insurance includingoperation"p ce of itels subcal work may issue unless stantil undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing oafecgeuivalent. The CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME. Licensee: LIC.NO.: Signature LIC.NO.: (If applicable. enter "exempt"in the license number line.) Address-. Bus.Tel.No.: —� J *Per M.G.L. c. 147, s.57-61,security work requires D t<n • arent of Public Safe Alt.Tel.No.: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally— S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner ❑owner's a ent. 7 Owner/Agent 01 Signature Telephone No. PERMIT FEE: $ as-o,