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Home My WebLink AboutBlde-19-006520 Commonwealth of Official Use Only Permit No. BLDE-19-006520 -1-1n) 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:5/17/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work df��ribed below. Location(Street&Number) 65 HAZELMOOR RD celz—R.•{ Ke-. SON Owner or Tenant Telephone No. Owner's Address 65 HAZELMOOR RD, SOUTH YARMOUTH, MA 02664 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: New receptacles,switches,&fixtures. 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 0 In- ❑ No.of Emergency Lighting grnd. grnd. Batter'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 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 Data Wiring: Heaters 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: 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: BENJAMIN NARDI Licensee: Benjamin Nardi Signature LIC.NO.: 50435 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:35 GREAT WIND DR, PLYMOUTH MA 023602778 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 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 63/1 -: Common.weakh o/2//assach.cdaltd Official Use Only _ 1== c� c2 -(eZ+o ``) =.=Sly=' a:parfinen.f al5ire Scrviced Permit No. == Sb BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked u V .`�`•' {Rev. l/CM . (leave blank) APPLICATION FORT PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachuscus Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /hQ ( 7-)( 7 City or Town of: YARMOUTH To the Insp ctor of Wires: By this application the undersigned es notice of his or her intention to perfo3m the ele 'cal work described below. Location(Street&Number) ('�' e. 1 ,Q c Owner or Tenant 6�e f,/l 1 e� r Zo r Telephone No.5O177 7:J C( Owner's Address ' , Is this permit in conjunction with a building permit? Yes ) No ❑ (Check Appropriate Box) t� -- Purpose of Building (2 5 i d L 0 G ,e Utility Authorization No. • M Existing Service /UD Amps r13 / z`{U Volts Overhead- Undgrd ki ❑ No.of Meters New Service Amps / Volts Overhead E Undgrd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Pro osed Electrical Work: "�ef `�C�e Vti /f 11T+ 1 do f 5 Slf�✓ / G Jc Completion of the follawin-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 It mergency Lightzng • arid. arnd 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 Total No. of Ranges ,No_ of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons H KW No.of Self-Contained Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local D Municipal - Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters KW No. 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: (�D )( Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO ERAGE: 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 and covera e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEOND ❑ OTHER ❑ (Specify:) I certify, under the painsdpenalties o ) fperjury, that the information on this application is true and complete. FIRM NAM : LIC.NO.: Licensee: / f A. A../- CI( Signature ' �—' _ (If applicable, t em (iq th icense number line. LIC.NO.: f f 3 S Address: ��j'Jr.? SI to y „tA0 g 2-3-3-6 2 Bus.Tel.No.:�� 3 L L( c.) el.No.: t "Per M.G.L. c. 147,s.57-61,sec ' work requires Department of Public Safety"S"License: Alt Lic.No.OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�— 5 required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner ❑owner's anent. Owner/Agent 1.11 Signature Telephone No. PERMIT FEE: $