HomeMy WebLinkAboutBLDE-22-005097 0 Commonwealth of official Use Only
Massachusetts Permit No. BLDE-22-005097
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:3/15/2022
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) 7 MEADOWBROOK RD
Owner or Tenant DESMARAIS JEFFREY M Telephone No.
Owner's Address PAPADOPOULOS HELENA A,7 MEADOWBROOK RD,WEST YARMOUTH, MA 02673
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:
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- 0 No.of Emergency Lighting
grad. 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. TTotal No.of Alerting Devices
on
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 Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs 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:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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
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cc77��e�oariaunE of ins Jirvaee Permit No.t.::::22--- sj-n
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] ---.—
(leave blank)
I APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordaaxx a with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/
1 City or Town of: 0, s �`���z
YARMOUTH To the Inspector of Wires:
1Ry this application the undersigned gives notice of his or her intention to perform the electrical work described below.
,ocatien(Street do Number) r) n'7 a/O,..> 6rc►vk ,f /
Owner or Tenant � ��� � �Cs �LrJ
Owner's Address 'y .44.w, s.�li� /J Telephone No. 7�y -2186 ye/2/7
Is this permit In conjunction with a building permit? Yes ❑' No
purpose of Buildin El (Check Appropriate Box)
g wL�� Utility Authorization No.
l xisting Service_2542 Amps ire/2','s Volts Overhead® Und
/4ew Service gt'd❑ No.of Meters _.../._Amps / Volts Overhead Uadgrd,❑ No.of Meters
Number of Feeders and Ampadty '
Irecathm and Nature of Proposed Electrical Work: . ve, / ,
Coat,letion the ofow ; table m, be waived,
No.of Recessed Luminaires Na of Cell.-Sasp.(Paddle)Fans o,o rhe I o�ror o Wires.
�t Na of Luminaire Outlets Transformers KVA
r1Na of Hot Tubs Generators KVA
t' Na of Luminaires Swimming Pool ',8ve 0 a- ❑ BIZ o 'mergency '1 ;ng
;' No.of Receptacle Outlets No.of Oil Burners Faorts
�, Na of Switches FIRE ALARMS No.of Zones
No.otCas.Buraen 'o+o h^ec:,n a, ,
1;.r Na of Ranges Inidadn Devices
Na of Air Coad. °'
Na of Waste u Tons No.of Alerting Devices
Diq>mers , Totals:imp �um, r ons _. _ a o ' m on n _,
Na of Dishwashers .. Detecdon/Akwtha Devices
Space/Area Heating KW Local❑ C.
no^^�
Na of Dryers HeatingCon.11 I . ❑ abet
Appliance KW . — ,— M ;
Na of uA,alent
o.o a - cea or •
Heaton KW o.o 'o.o Data Wiring:
S a Ballasts fD
Na Hydromassage Bathtubs Na olDevices or :uivalent
No.of Motor Total HP a ammo, , : ns " ,g:
OTHER: Na of Devices or • ,utvaleat
Attach additional detail Ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
(
Work to Start: Inspections required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the
the,licensee provides proof of liability insurance including"completed pt"coverage of is subcal work may lest.u Mess
undersigned certifies that such coverage is in force,and has exhibited prooperation"
f of nsame to mea or i substantial equivalent. The
CHECK ONE: INSURANCE ❑ BONDpermit issuing office.
. I certify,under the pains and 0 OTHER 0 (Specify:)
penalties ofperjur,that the Information on this app/kation is true and eoatplete.
FIRM NAME:
Licensee: LIC.NO.
Ifapplicable.suer"exempt^in the Incense number line.) Signature LIC.NO.:
Address: Bus.TeL No.: �—"
*Per ass: .c. 147,s.57-61.security work Ale.TeL No.:
*p .M.R'S INSURANCE ` neq""'s Department of Public Safety"S"License: Lic.No.
---------
OWNER'S
by law fr WER: I am aware that the Licensee does not have the liability insurance coverage normally
Owner/Age . ; below,I hereby waive this requirement. I am the(check one I owner
Signature ■ owners :ent.
�/ Telephone No. 27y 2��-/a�� PERMIT FEE:$ $b