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HomeMy WebLinkAboutBLDE-23-004250 Commonwealth of Official Use Only &RI '• Massachusetts Permit No. BLDE-23-004250 ....,,, 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:1/31/2023 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) 15 BELLEVUE AVE Owner or Tenant CROCKETT CARLETON Telephone No. Owner's Address 15 BELLEVUE AVE, SOUTH YARMOUTH, MA 02664-3101 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appr B1'iate Box) Purpose of Building Utility Authorization No. K�77 ` Existing Service Amps Volts Overhead 0 Undgrd 0 • . i.of ,t1 New Service Amps Volts Overhead 0 Undgrd 0 o' . 7 Number of Feeders and Ampacity / E�,°",;; ;,-.� Location and Nature of Proposed Electrical Work: Kitchen, Dining, 2nd floor bath, New 30 Circuit Panel ' f �.�.` ..: �, ti Completion of the following table may be wdi,v4 ~ At\insp f or of Wires. " No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of `,,� ..``, tat Transformers 'N j TirNo.of Luminaire Outlets No.of Hot Tubs Generators s , 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 Initiatine 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/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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: EDWARD M LYNCH Licensee: Edward M Lynch Signature LIC.NO.: 35609 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 WIDGEON LN, WEST YARMOUTH MA 026733818 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: $75.00 RECEIVED [-. ; ] 3 1 Cansesonwea[!h a/rr/aeeachaeeila Official Use Only U BUILDING !-NT ..�eparimeni al 5iee Services Permit No. �-y.7'- -/2-C✓d By ARE/OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev.1/07] (lavebienk) APPLICATION FOR PERMIT TO PERFORM ELE TRICAL WORK 1 All work to be performed in accordance with the Massachusetts Electrical Code(M 527 MR 12. 'PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Insp ctor o Wires; . jty this application the undersigned otic of his or her int tiny to orm the ale triad w rk described below. Location(Street&Numb r) y Owner or Tenant Q Owner's Address 19' l ©�'r D��� Telephone No. . Is this permit In conjunctlo with a"sliding permit? Yes !I No Purpose of Building conjunct)" 2 L 1 �t2 ❑ (CheckAppropriate Box) (,l�•�/ Utility Authorization No. Existing Service /I O Amps rdO/d 'Volts Overhead ❑ Uudgrd71 No.of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters Number of Feeders sod Ampaclty Location and Nature of posed Electrical Work: !drew rl-ice/ira � � D° -� ('mpletion of the followin&table mre be waived by the In 7 lector of Wires. u1 No.of Recessed Luminaires �� No.of Cell.Sasp.(Paddle)Fans Transformers °f oral Ca No.of Luminaire Outlets Tr KVA No.of Hot Tubs Generators KVA d' No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting end. end. ❑ Battery Units ` _� No.of Receptacle Outlets / No.of Oil Burners -t, FIRE ALARMS INo.of Zone-. No.of SwitchesNo.of Gas BurnersNo.of Detection and - t`t No.of Ranges Total Initiating Devices g No.of Air Cond. Tons No.of Alerting Devices No.of Waste DisposersMeat Pump Number Tons KW 'No.of Self-Container" Totals:I -.__......'Tons 1 - Detection/Alerting Devices No.of Dishwashers / Space/Area Heating KW Local❑Municipal No.of Dryers / Heating Appliances KW Security Systems:* ❑Omer 'No.of Water No.of No.of Devices or E quivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wring OTHER: No.of Devices or Equivalent 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: 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 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 r LIC.NO.: Licensee: Signature (If applicable,enter'uegtp•'i7tl� 'celfre rum r(hoedLIC.NO.:_ � Address: Ir`' �1 All, (�i � Aft Bus.Tel.No.. /y �'.f,� _ Per M.G.L.c.147,s!5Y AC 1,security work requires D9'actment o u lie afe "'S" accuse: Alt L cL No. 9 1 OWNER'S INSURANCE WAIVER: I am aware I t 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 a:ent. Owner/Agent Signature Telephone No. PERMIT FEE:$