HomeMy WebLinkAboutBLDE-22-000805 Commonwealth of Official Use Only
E`. Massachusetts Permit No. BLDE-22-000805
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:8/12/2021
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 descr�'' `4 bel w.
Location(Street&Number) 16 WINSOME RD M ` t� -i• Al
Owner or Tenant Telephone No.
Owner's Address N0" - . .:..- ' ' _ •--- - ------- _ --•-- • _ _-- - ' . : 3
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: Mini split install
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 Emerge, Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALA'tvA 'es,i,
No.of Switches No.of Gas Burners No.of • . a + o
Initi, 441 • 4,
No.of Ranges No.of Air Cond. 1 Total No.of Ale ' DA,
Tons
No.of Waste Dis osers Heat Pump Number Tons KW ,No.of Self-Cont�'ed
p Totals: Detection/Alertine De40
le) b:i?
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal a
Connection 4
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 Siens 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: JOSEPH V SLOWEY
Licensee: Joseph V Slowey Signature LIC.NO.: 11186
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 168 WATERCOURSE PL, PLYMOUTH MA 023603629 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
.... -en-64
, .
R E C V E ® Ceou sam+saftA 1a . ;�� Only
4 a}'1 2spart+s snt el. ii s�ort+rcre
CAU 4' occupancy and Fee Checked
.RD OF FIRE PREVENTION REGULATIONS [Rev. I/tl7j
B
DING .. . 'T M (leave blank)
By - ION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
6 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8-" /0 . dr-) ./
ti
City or Town of: i (,Y r m Ow Th To the Inspector of Wires:
By this application the undersignedgives notice of his or her intention to perform the electrical work described below.
4' Location(Street&Number) )/o IA)il)S 0"n- .0 d
,, Owner or Tenant /'I)i ice G a,')r S Telephone No.,
Owner's Address
• Is this permit in conjunction with a building permit? Yes 0 No 12 (Check Appropriate Box)
Purpose of Building eesid n c Utility Authorization No.
0' Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
jNumber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: w/r t, di..ec n n-e C 7 4,- 111,,-); SOi It
Completion of the foiiowing table m be waived by the I for of Wires.
No.of Total
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)FansTransformers KVA
9 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
jlboveIn- No.of Eme en L tin
No.of Luminaires Swimming Pool trod. o oynd. o aatteg Unit i g
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No.of Switches No.of Gas Burners Initiating Devices
Ili No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Heat Tone
No.of Waste He tt Pump Number Tons `No.of Self-Contained
es Totals: Detection/Ale ,.1 Devices
No.of Dishwashers Space/Area Heating W Local❑ Mun M +
IoConnec0 Other
tion
No.ofers Heating Appliances KW Security Sy stems: '
' No.of Devic-a or Equivalent
No.of Wates KW No.of No.of Data Wiring:
Heaters signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Tel No of Devices
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: 700' (When required by municipal policy.)
Work to Start: b'"• /0`d( Inspections 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 TY BOND 0 OTHER 0 (Specify:)
I cer fy,ander the pains and penalties of perjury,that the information on rids application is true and complete.
FIRM NAME: j t/.S 6/ec r r. C t a r) LIC.NO.:
Licensee: c) ( .S lb(-Of Signature f17/1/7 LCI V Zf LIC.NO.: i/i g-:. 13
Of applicable,enter"exempt"in the t rinse mimber line.) Bus.Tel.No.;.S v8 3to 2 A 8'11)
Address: Ifi� 6' GUa rerca i r e 4C?1 1/ mea /L)/ i'Yt a. O a3 la d Alt.Tel.No.:
*Per M.G.L.c. 147,a.57-61,security work requires D partment of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: l 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 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 6-UJ