HomeMy WebLinkAboutBLDE-21-006573 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-006573 E ';
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
LRev.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:5/13/2021
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) 18 HIALEAH AVE
Owner or Tenant BROWN WILLIAM J Telephone No.
Owner's Address BROWN JEANNE M, 18 HIALEAH AVE,WEST YARMOUTH, MA 02673
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 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: Renovate 1st floor bathroom.
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
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 0 Municipal ❑ 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 Siens 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: EUGENE J EMERSON
Licensee: Eugene J Emerson Signature LIC.NO.: 20136
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: PO BOX 1122, ORLEANS MA 026531122 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 ❑ owner's agent.
Owner/Agent
Signature vTelephone No. PERMIT FEE: $75.00
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I BOARD OF FIRE PREVENTION REGULATIONS [Re.e•°cc lm midr Fes `
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(Neve Wank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to bs psrfbnusd in aecerrho a with the hiset.ctroatte Elssuiral Code(MEC)`327 CMR 12.00
(PLEASE PRINT/N INK OR TYPE ALL INFORMA77ON) Data 5/4/2021 •
City or Tows oft Yarmouth To the Inspector of Wins:
By this application the undersigned Lives notice ethic or km intention to pedant'the electrical work described below.
Localise(Street tit Number) 18 Hialeah Lane
Owner or Tenant Jeanne Brown Telephotos Nw508 398 3274
Owner's Address
Is tide permit In co juectlon with a building perm!!? Yes ® Ne 0 (Cheek Appr prlate Iles)
Purpose of mews Home Utility Autkaisades Na
Existing Santee 100 amps 120 /240 Vela Overhead❑ Undgrd❑ Na of Meters 1
Pica Ssrvibg Amps / Volts Overhead 0 Uadpd❑ Me.of Meters
Number of'seders and Ampasity
Location and Nature of Proposed Electrical Works 1st floor bathroom renovation
t:o rtleffeaofthootkr ioeeblraegbewM,eedMMsbytoot renfWirer.
Me.et Recesad Luminalns No.of CsWesa(?id �a)Taos � Tsollsnoers OY
No.of Laminalee Outlets Ha of Het Tubs Gmee ants KVA
?la of Lomiasiree swimmable?"Atbve ❑ in- ❑11OG es suniri■Ilenel Wig
pNe.of Reeeptssle Outlets No.if Cl Borate PIRt ALAMIS I146,of Zones
U " ryes KiN
Nw of Switches No.et Cam Beteeare
Thwkis
EKa of Ramps Ms.of Air Coati Tons ge e Ne.of Alertl.g Dermas
46 No.of Waste Dlspesers T l Number Veit
LXW he.of• Mdtned
No.of Dhkwaahers SpnafAre.lileedag KW PaamildssiLed❑ ❑ Odor
o Ne.of Drpere Hnd.g A Wag" KW sieif err EnuH►aleert
N 1rw otws KW Aw K Ms.d Dad
E ' �� w
Heaters
NMs.Hydranasege Bathtub. Me.of Messrs Total HP r NeL�Dinka or
DIOTHEIU
both ariblawod J toil Vs or or ropirwibp de!rime,of Wire:
Estimated Value of Electrical Work (Whoa required by sm.nieipet policy.)
Work to Start 5/10/2021 inspections to be requested in accoidsnce with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the aeoter,no peentit fin the perfbrnrasoe of electrical work nosy issue unless
the licensee provides proof of liability insurance including"completed opsretioe°coverer or its subetuad&eg.ivalme. The
undersigned certifies that such coverage is in torso.and has exhibited proof of same to the porn*issuing office.
CHECK ON& INSURANCE ® BOND ❑ OT)11D1 ❑ (Specify) 2.0( 2✓
62
A I cone,war dm*ne and pensWa ofposinm that she InIon eidon on Ale m p4aatiars Re trim m ai agra\
—.4 FIRM NAbll: Fm_erson Flectrical Construction Inc. LIC.10►s 2687 Al
i Mauna Eugene Emerson 1lgeaIu� ' Ci C "frPBoa.Tel.rill'
255 9�8
♦„( (Ifappfkoblo.wow"mo e"be the Know pnoob r 16ra)
Address, p 0 Box 1122 Orleans. Ma. 02653 .�It.TsL ��nIll•Per M.QL c. 147.s 31•b1.security work requires Depattmeet of Public Sally"S"License Li..
OWNER'S INEUI.11'ICt WAIVER: I am swore that the Licenses dam not hors the liability*MOM coverts*normally
required by law. By my ligneous below.I hereby waive this requirement. I am the(check one owner n owner's apart.
Ownsrblpet
Signature Telephone Na PERMIT FEE:S 75.00