HomeMy WebLinkAboutBLDE-22-004641 dp Commonwealth of Official Use Only
(ONNeti Massachusetts Permit No. BLDE-22-004641
41ftems BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/071
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:2/22/2022
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 SHALLOW BROOK RD
Owner or Tenant Brian Ulman Telephone No.
Owner's Address 7 SHALLOW BROOK RD, SOUTH YARMOUTH, MA 02664
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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Miscellaneous work per attached.
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. Tn Total 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 ❑ 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 Eauivalent
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: PETER PETO
Licensee: Peter Peto Signature LIC.NO.: 14763
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 132 Wintergreen Ln, Brewster MA 026312258 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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w. B 22262 t O/Mtdme�ildl d Official use
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and Fee Checked
N,�. —.',-0 • FIRE PREVENTION REGULATIONS [Rev. l/07j (Leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Mt worts to be performed in accordance with the Massachusetts Efestrical Code },jc
S2? 12.00
.� (PLEASE PRINT IN INK OR • 'ALL INFORM ON) Date: 2
City or Tows ofi a r�l/V lO To the 1 of ires:
By this Location hduesum6er, '' ;.ii� �VOW liis or her�� 'Y°Oeekion to��electrical work described below.
( ) 7 C'./ vQ
Owner or Test 1t ca v\ ( h.A Otit,\ r Telephone Na
,* Owner's Address
Is this permit in cool with ii Purple le Bedding '7P e s,dL Yes 0
V No ty Authorised**No. Butt)
i Exist Service Amps / Volts Overhead 0 Vndgrd 0 No.of Meters
\ Net Amps I Volts Overhead.Q !Judged 0 No.of Meters
Number of Feeders sad Montky i ,
A'rta
d Nature of E Work: fi5. (S4-U CG S"
ZC7-55:a stec� eatj vw r cks ct e-t- &c i c �--S
1, Cowie****fibs of ii cera��br the o Whys
No.of Rem Le acres No.of Celt Swp.(Pare)Fens i+Gif.ot`
Tanartsen Teta
KVA
Na of Lac Outlets No.of Hot Tubs Generators KVA
'No.ot kostrigrerey utensil
No.ofl�* Swimming Pool Above ❑ t ❑
Na of Receptacle Outlets No.of OR Burners FIRE ALARMS JNo.of Zones
Na of s u iaed
ps No.of Gas Barmen No.at _• ___ ti
Na of Ranges No.(JAW Cond.d. Demfiees
lotUna No.of Akrtl g Devises
Na of Waste Disposers .. ietd
Heat Pump UWE
Na of Dishwashers Space/Ares Heating KW �� ❑Oder
fat I
e.of Dryers Besting Appliances KW Eggiyafigio
Na of Water KHeatersW NSigns o.
Dots Wittig
11f
IT Na of Der or _;,�,,i, , t
Na Hydroinassege Bathtubs No.of Motors Total HP Na of or
OTHER:
Eatinriafird'Value ofkirk additional derail trashed,or tv rimed by the Inspector ofrote
Work: (When requited by municipal policy.)
Work to Start: 2— Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO E: Unless waived by the owner,no permit for the perkemante of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substatsial equivalent.d fed certifies that such .40.< :. in is fore and has exhibited proof of same to the permit issuing office.
1C
ten
CHECK ONE: INSURANCE = BOND 0 OTHER 0 (Specifv:)
I wet,
FIRM WAta M>E. ,� t Gti1 orr k arwe and
cam: (e Ue.NO.: 4 `i 63
e i3,
rpQ k o Signature C.NO:
-," I „ Bus.TeL No.: `) ti II—at/to —en e.�
�' W � tb 1��S Alt.TeL No.: y
*Per M.G.L.c. 147,s.57-61.security & inquires Department ofPublic Safety"S"License: Lle.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee see(kw not here the liabil*insunmce coverage normally
required hy law. By my signature below.I hereby waive this requirement. I an the(check one)CI owner 0 owner's agent.
Signature Telephone Na i PERMIT FEE:$
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