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Home My WebLink AboutBLDE-23-004772 , / r ofIX) Official Use Only or Commonwealth of � Massachusetts Permit No. BLDE-23-004772 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:2/28/2023 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 e e ' al work describe below. Location(Street&Number) 25 PINE ST Owner or Tenant Adam Waitkevich Telephone No. Owner's Address 11 Gilbert Way, Millbury 015270000 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: interior remodel(508-776-1128) 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- 0 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 _Initiatinu 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 Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Sins No.of Devices or Eauivalent 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 0 (Specify:) cfi(� 7`4, - /(ZQ I certify,under the pains and penalties of perjury,that the information on this application is true and complete. �J U FIRM NAME: Stephen M Peckham Licensee: Stephen M Peckham Signature LIC.NO.: 19877 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: PO BOX 367,CENTERVILLE MA 026320367 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 .^_�. ��5 er Pr (o%f dP IJ Cr�1 t OP O oq) r �,.—.• Q�'�'% r 1 Cv(z3 1)1t�lwC.44. (o 4(23 R.p ci,ti QQAT-64 047 ree66.) tiFt-. elkA-9 Ke, ‘, 1 2-1(' g96r7 (Allt".9 " c l vt, 1I V( a, �Pt,�1 t9'(� . - Co n nonweaa el//lamac�udetta Official Use Only ""`ryr cc77 Permit No.5�E Z 3 DO -# _ ^ .2epartment ol..tieo Serviced Occupancy and Fee Checked 73 Ct Q BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) ULI ry,,a PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK '"„ 2 All work to be performed in accordance with the Massachusetts Electrical Code( C),527 CMR 12.00 w rA (Il ISE PRINT IN INK OR T P ALL INFORMATION) Date: 0, -?-, • co Ci or Town of: In/t..0 O`V'\l, To the Ins ector o ires: w pi!! i. application the undersigns gives notice of his or h r intention to perform the electrical work described below. w,1 ' 1i m mr on(Street&Number) O..b P l,Ae___ ryylj ty Map Parcel# • , . or Tenant V,)ICU� k.) ..4kKeN(IGh 5 " 1 Telephone No./)-a?&-c117q Owner's Address i)core.— Is this permit in conjunction with a building permit? Ye No ❑ (Check Appropriate Box) Purpose of Building �e.."52...sz__ Utility Authorization No. Existing Service Amps 100/c (( olts Overhead ❑ Undgrd❑ No.of Meters l New Service Amps / Volts Overhead❑ Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �,t j.t. D, (,eL Completion of the following table may be waived by the Inspector of Wires. NoNo.of Recessed Luminaires Tr 7 No.of CeiL-Susp.(Paddle)Fans f T Tranosformers KVA No.of Luminaire Outlets I a No.of Hot Tubs Generators KVA No.of Luminaires ( p Swimming Pool Above ID In- El No.of Emergency Lighting grnd. gmd. Battery Units No.of Receptacle Outlets (.0 No.of Oil Burners FIRE ALARMS INo.of Zones II No.of Switches A No.of Gas Burners Ai No.of Detection an C7 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 I Space/Area Heating KW Local❑ Municipal ❑ Other l Connection No.of Dryers L Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water i KWf C No.of No.of Data Wiring: Heaters i J 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:I to L (When required by municipal policy.) Work to Start: ,.I Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived by the owner,no permit for the performance-: - - al work may issue unless the licensee provides proof of liability insurance including"completed operation"covera.a or its subst. ial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof',tame to theh^ permitisuing ffice. CHECK ONE: INSURANCE ,BONI) 0 OTHER 0 (Speci t �: •Z3h'C L€-- I certify,under t ains and pe hies f perjury,that the informati i ,1 ,: , ,, '•, ',, •e and completes _ _ FIRM NAME: �St. /;" LIC.NO.:t7b 7 7'�, Licensee: n/�� Signatur: 'A, LIC.NO.: (Ifapplicable e erexemsitm erline.) V � ,� Bus.TeL No.5 b�r Address: IG� � -� [C'I ' Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work equires 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 ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ' IMPORTANT: A separate permit is required for the installation of smoke detectors.Fire Alarm inspections are performed by the FD having jurisdiction. T �-. rn v�