HomeMy WebLinkAboutBLDE-22-003832 Commonwealth of Official Use Only
or ` Massachusetts Permit No. BLDE-22-003832
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:1/10/2022
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) 5 GREYHAMPTON RD
Owner or Tenant NEYLON JOHN G TRS Telephone No.
Owner's Address NEYLON DIANE E,23 BOYLSTON ST,WATERTOWN, MA.02472
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: Split NC
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 1 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. 1 Total 4 No.of Alerting Devices
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 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 Equivalent
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 0 (Specify:)
I certify,under the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: Carmine R Dambrosio
Licensee: Carmine R Dambrosio Signature LIC.NO.: 12369
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:255 NORTH RD,UNIT 40,CHELMSFORD MA 018241406 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:$50.00
Olt 3(` tine.
, ,. A C.......11#1.4.1.4
Ciel Use ally
Aw t_ h.�!t'.i6h.. •gar. Pernik No. Z- - 3 g 32 —
_ BOARD OF FIRE PREVENTION REGULATIONS Rev. Pee p'ed"'d ism .`....._.,.._,_
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
MI wodt to be performed to isosrdmoe with the Mee humus EJeett$cal Code(MEC).527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dote: V L,)-0d-1
City By this application or OWI of:• c.rAo-1- h To the Inspector of Wins:
S vet notice o or intention co perform the electrical work described below.
Leeetka(Street&Number), S 6reYr h--(. p4-0 n I .
Ownor Tallest `�I, /lie y/o.)
Owes 'Woks.Ira b 17-5 y 1_-Ro9I
Owner's Address J3oyl sin .sfrep.,+- VA, o , /i4 a y 7c)-
Is this permit le seojunetlos with a banding penult? Yee 0 Ne V (Cheek Apprepdste Iles)
herpes of Betiding Res .,1 G e, Utility Authorised.*No.
Widow Sink* ‘0_ Asps i a.° /)-y o volts Overhead : -- . firefilikarre .1
amiliggs Asps , I Vola Overhead 0 Uedad 0 Ne.of Meters
Number sgreedsre and Asperity
Location(- and Niters of Prepared Electrical
Work: i,,sj lie,L 'o - co� „I c y fo 1M I J si los S'1 r CO ade,s-e r *1, . 6 dl c /e c E,-,-) Co' •x S
l
C• - : lien - the allows t0• e i • we d b I I. I •�.•.Wires.
Na of Resesssd Lentivaitee Na of CslL•$wp.(Peddle/Fon tT ao kroun A
No.of LlaslaeIre Outlets No.of Hot Tube Geserelera KVA
Na of LuAtstslna �pealAOovt ❑ nth C ]'melee ineergeney LOW'
No.of Neaps*Outlets 2 Na of Oil Sumas FIRE ALARMS Na of Zees
No,of Swaim No.*IQBeniern 'Ra loillatia-, • ....".~
Ns.of 0.1.11 Na of Alr Coed. d__ -Tel; L Na of Alerting Devhus
Na of Wash Disposerstea NO�� ,.,, w_die.OtSI!►,Cas■ttwe
Ne.of Dishwasher, $p ss/Aree Heating KW Loral❑ ❑ Other
Na of Dryer. Reality Applies** KW f9a em
No.or Data
HeatersKW 'Ne.of Na of or Et �iut
Mir Belle*
Na Hydrowaesa$1 Bathtubs Na of Motors Total HP ' ,-_;11,"4:-T. 4"
ER:
Attach additional detail(Tanked or or revoked by Mr*rector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 1,- 1S/�-off inspections to be requested in accordance with MEC Rule 10.and upon completion.
INSURANCE CO ERAGE• Unless waived by the owner,no permit for the performance of electrical work may issue unless.
the licensee provides proof of liability insurance including"completed operation"coverage or its subdivide!equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ®, BOND ❑ OTHER ❑ (Specify)
I est*,wailer AV plus sad penalties of perjury,that Me information on this application is true and
FIRM NAME: ' '.so 64 WG NO.:AI 4361
Uese.a.: C a.r ehrr,t. R. p'4 n► • rhea ts,1 S$Etatsr...,S ,-------„,.,,,,`, LIC.140.: 11 Y 7 9 6
fn'appI cabtt.eller ”esemp►"at the Meow number him.)
Addr..s: ,1,1., /h.r2 Or 1 -0°4-2 lar 4/0'44 R!1 t AAt '1'1V Bus.Tel.N ., a st- (Si -ivS L
*Per M.O.L.c. 147,s.5741,security workcSafety"S" _ Mt. TeL No.,
OWNER'S INSURANCE WAIVER: 1 tat aware Departmentioauee dues not hone the liability insurance: Lie. o.
reqOwred law. By my signature below.I hereby waive this requirement. I am t s(cheek oo' a madly
age ( one ■ owns ■ owner's s.
TtIipboae Na PERMIT FEE:$ S 0