HomeMy WebLinkAboutBLDE-21-006343 or i 2\ tel Commonwealth of Official Use Only
.�, `K Massachusetts Permit No. BLDE-21-006343
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:5/4/2021
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 described below.
Location(Street&Number) 7 CIRCUIT RD EAST
Owner or Tenant Carla Warburton Telephone No.
Owner's Address
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: Installation of solar PV system(18 Panels 5.85 KW)
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- I: 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 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: Lloyd R Smith
Licensee: Lloyd R Smith Signature LIC.NO.: 15688
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 30 1ST ST, MELROSE MA 021764010 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $150.00
Commonwealth o/ amactte Official Use Only
-=R 2( —(03 4 3
� �._C/ cc'�� Permit No.
i -B_' Permit
o/.)ire�eruices
- !j-s" Occupancy and Fee Checked
'v,,_ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELE TRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(M C,527 CMR 1'.00
(PLEASE PRINT IN INK OR TY E ALL INFO ` 1 OWN) Date: 21 I •
City or Town of: m C� ✓ \ To the Inspecto of Wires:
By this application the undersigned 'ves notice of his or her intention to perform the electrical work described below.
Location(Street&Number) C I V GUI P — •
Owner or Tenant ClaL,(/� WCLA/ IOU 1'1 Telephone No 28
Owner's Address SoC,rne 4L.S
Is this permit in conjunction with a building ermit? Yes g No ❑ (Check Appropriate Box)
Purpose of Building I ( Utility Authorization No.
Existing Service 1( 0 Amps (2.0/?3-4(lts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: I n S--c9 1 I I T mo,D(\-- -,--1)
So\ct- toccnI s — . s
Completion
e)F of the followingtable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.�us (Paddl ans No.of Total
p• Transformers KVA
8 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
CNo.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
C. — • No.of Waste Disposers Heat Pump
Totals: Number Tons KW No.ofSelf-Contained
Detection/Alerting Devices
f n No.of Dishwashers Space/Area Heating KW Local
❑ Municipal Connection ❑ r
v 1 No.of Dryers Heating Appliances KW 'Security y tems:*
No.of Devices or Equivalent
1 No.of Water KW No.of No.of Data Wiring:
(3 Heaters Signs Ballasts No.of Devices or Equivalent
/ No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring
No.of Devices or Equivalent
/ .11 OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of lectri l Work: I—DD.O.V-t) (When required by municipal policy.)
Work to Start: S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO RAGE: 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 suchcoverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under ih€pains and penalties of perj ry,that t e information on this�ppplication is true and complete.
:s
C:-V
FIRM NAME:v`1/ h r V.4I 1/
Licensee: I--t Uy OI �.. S m 11.,h Signature NO.: 15 V.&f
(If applicable enter"exempt' in a license number line.) Bus.Te. o.•
C Address:&IS M.41eD S ,p�IS h it Utl `'1Z(.c�11 �- All TeL No.: `-11 2-10
*Per M.G.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)0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE:$
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