HomeMy WebLinkAboutBLDE-22-006313 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-006313 _
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:5/3/2022
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives noticc of his or her intention to perform the electrical work described below.
Location(Street&Number) 12 GATE WAY
Owner or Tenant Angela Cox - Telephone No. ,(///'
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Bo;,*
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: Wiring for fire place.
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
Initiating Devices , - A(\
No.of Ranges No.of Air Cond. Total No.of Alerting Devices `J
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: I
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: JOSEPH V SLOWEY
Licensee: Joseph V Slowey Signature LIC.NO.: 11186
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 168 WATERCOURSE PL, PLYMOUTH MA 023603629 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
Commonwealth o////assachusdtls Official Use Only
m_v = G ` ` �1/ Permit No. Z2 -6,5t
—_lo_ Theparlmen1 o/Jire Services
l Occupancy and Fee Checked
—,-tIL-------
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
'�;,� - (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
aAll 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:4/28/2022
rt
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.
2` Location(Street&Number)12 Gateway St
Owner or Tenant Angela Cox Telephone No. 781-801-0698
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No Fil (Check Appropriate Box)
Purpose of Building Residence Utility Authorization No.
El
Existing Service Amps / Volts Overhead ❑ Undgrd No.of Meters
New Service Amps / Volts Overhead n Undgrd I 1 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: wire fire place
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
C Transformers KVA
j) No.of Luminaire Outlets No.of Hot Tubs Generators KVA
�i No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of UnitsEmergency Lighting
grnd. grnd. Battery Units
(/ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and i
No.of Switches No.of Gas Burners Initiating Devices
Q No.of Ranges No.of Air Cond. Total
Tons No.of Alerting Devices
-1"1 Heat Pump Number Tons KW No.of Self-Contained
.,h No.of Waste Disposers Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other j
P Connection
(b Security Systems:*
No.of Dryers Heating Appliances KW No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H
Y g No.of Devices or Equivalent
3 OTHER:
Q Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 650 (When required by municipal policy.)
Work to Start:4/28/2022 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
' e 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
C undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
$ CHECK ONE: INSURANCE I BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:JVS Electrician LIC.NO.:
Licensee: Joe Slowey Signature/tjjl( V LIC.NO.:11186B
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:508-326-2280
Address: 168 Watercourse Place,Plymouth,MA 02360 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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ i