HomeMy WebLinkAboutBLDE-22-006956 11\1J Commonwealth of official Use only
956
E. � `
Massachusetts Permit No.0 BLDE-22-006
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 Codc (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:6/2/2022
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perf4iii the electrical work described below. l
Location(Street&Number) 174 BAYVIEW ST 08 1/ 1 c8 —7(/ Q,5.0
Owner or Tenant JEWELL RONALD Telephone No.
Owner's Address REILLY SANDRA, 1101 WORCESTER RD, FRAMINGHAM, MA 01701
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: Remodel 1st floor kitchen. Change switches, plugs, &lights.
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- ElNo.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 ❑ 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 Sinus 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Frederico M Furtado
Licensee: Frederico M Furtado Signature LiC.NO.: 13405
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: .
Address:71 HATHAWAY ST, NEW BEDFORD MA 027462352 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
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k `,' DING DEPART M Lis c7ip,&mom Permit No.��
,� BOARD OF FIRE PREVENTION REGULATIONS �,Occu 1/07] and Fee Checked
(leave blank)
-- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
'iliii 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: 6 l/ /a
V City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersig es notice ofhis or berintendon to perform the electrical work described below.
Location(Street&Number) / 7 L/ ✓ 14,/ �"f ett� �j T
Owner or Tenant ) /3 � x / Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes Er No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
ExistingService A4m / Volts Overhead Pa 0 Undgrd 0 No.of Meters
N New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
\N Number of Feeders and Ampadty
4- Location and Nature of Proposed Electrical Work: R o i a .i S 7 /-2. l4,m/y o r-
0,. _ji--/4 vj e �viiiicNf41PI t'9-C AA/d I.-i 7//5
Completion of asefollowinxtabk may be waived by the Inspector of Wires.
Lb No.of Recessed Luminaires No.of CeL-Sasp.(Paddle)Fans No.of Total
Transformers KVA
'i No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminairesgig Pool Above ❑ In- ❑ No.os Emergency Lighting
urnd. fond. Battery Units _
No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones
r No.of Switches No.of Gas Burners 'No.of Detection and
4 Initiating Devices
IV No.of Ranges No.of Air Cond. T i No.of Alerting Devices
No.of Waste Disposersons
Totals:
Pump Number Tons __�KW_.,. 'No.of Self-Contained
Totals:_ Detection/Alerti Devices
No.of Dishwashers Space/Area Heating KW Local❑ Muni! ❑ 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 Devicce.�or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNofDevicesor Wiring:
Na of Devices Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 2,.(J d C) (When required by municipal policy.)
Work to Start R S A Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERA : 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 IT' BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penaktes of pesjury,that the information on this application is true and complete. /�
FIRM NAME: _ LIC.NO.: ).3 'l0 /-�
Licensee: -2?e el e fe t c d f- a,t7�d e Signature eta,/�G LIC.NO.:
(If applicable,enter"exempt"i the license number line.) Bus.TeL No.: 7 7 e-/ (-/s / (/5 73
Address: /r A vd R I c 1< 5"7' /g C e•S f iil/P T Pr I i 3 Alt.TeL No.:
*Per M.C.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 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$
8/1Q.L22,8:35 AM Accela Automation
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