HomeMy WebLinkAboutBLDE-22-005689 0,.--. Commonwealth of Official Use Only
" E. Massachusetts Permit No. BLDE-22-005689
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
LRev.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:4/5/2022
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) 67 CRANBERRY LN
Owner or Tenant Karen Myers 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 ❑ 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: Install generator.
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 1 KVA 20
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. Tonal 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 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: Marcelo R Soares
Licensee: Marcelo R Soares Signature LIC.NO.: 13036
(If applicable.enter"exempt"in the license number line.) Bus.Tel.No.:
Address:53 FALMOUTH SANDWICH RD, MASHPEE MA 026494307 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
C //e('Yv/
RECEIVED
j`�f c3iadwei.2i
D5rial Ilse Only
�, 0 5 2022 . . I
1APR
__- - . doeupamli and_Fe a Chinked
,_ t t� �` }h, TP REVELATION REGULAflDfvl5 [Rev. )
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Al woctto is pew in seenacdniee wen lie liasumelnesets Elul Code(Aft? SZ7 WILLUD
�`• (p
r. '4, 'FEINT.N .ET 'ir o7ALL.INFO O1� )
] z1 Cit (( j!7l'
city or Town at lettI.MG A-- To the Inspector of wirer:
G By this applicationtke undereigoed gives rotas zxf'lxis or her ideation to pedra>m tee elestri®l wow des;nalcid below.
Location(knee&Number) (off' G ILAhJ 9-)64-11 LN,
(j) s O^sroer or Teaanf 14441.1-1 MV4-S Teleplasm Na Ciit---1.9`1- `li-54C,
i. Is this pet'ix cnnjirottioa with a bidding permit? Yes ❑ No ❑ (Cheek Appropriate Bim)
Porpoise of Nairn • lintikorisation Na
bg Service Amps / Volts Oveduad❑ IIndgad 0 Na of Meters rsrs
New Ferri= !laps I Volts Drerlm:ad❑ IIndgrd 0 Na of
Number of Feeders ander
LsicrEuni and Nast of Proposed Eleetrical.Work 19 K-wl ( -1-ft- - tut-r1-4 ZOO.
`TtLAT,f4-lm- cArk rt h
Couple=of the ,,I. :.,-tate way be waived by the Inciiecter o}"fe=z
Na ofr.�B -d Lanrbsaires Na of Cal-Sucp..(Pads)Fans Na of Total
'I'rausformers KVA
Na of Luminaire Chtids Na.of flat Twin General= KVA
•
. 5 T arreri*r�in.e Above - 1 a at?:mm. =y Legating
Na of .Swiva>a ng-Pool crud. ❑ ted. ❑ n„*,.ry IIn .
Na of limeeptarle Deka Na of DELI:nen - ■: : ALARMS PMS Na of Zones
.�. - 'Nn.of Roliabrr Na of Oras Barnesa oTf,�D,e,m,��on and
i+�+r+++�C Devens
• .2 Na of EVI m 'Na of Air Cond.
Tons t a of Alerting Devizes
Na of-Waste.Dispose= Total=
Pomp Nu:tuber Tate KW a of&m ' ez
It-C^ '+n
Totem Dedz¢;on/Aleridaz Devi=
c Na of Disliwanhers Spars/Area He-sfiag KW Lozol 0 mitni,Vma. 0 mer
_ t
Na of Dryers EIcitio.g.Appliances KW Na of Devises or Equivalent-
'-'S
Na of Water KW
of Na of Data Withap
Heaters Signs Ballasts Na of Devices or Equivalent
Telez:omt r�'ons -1ring:
Na +-s+ 4 Pel abs Na of Motors Total HP Na off Devices or Equiralent
DIMS:
Al . &sal"desired or err minaret'ed by the invieciar(Pre=
f) let; .d Vali=of'Fleetzie 1 Wodc CWbrmrequired by rossiiripal policy.)
Work to&'tart Inspedicras to be re ueched.in aux with.MEC Rale LQ,aid upon czsapletion.
INSURANCE COVERAGE: Unless waived.by the zraea¢,no pem for foe pa:foamoe of electrical work may issue=less
the licensee provides proof of liability±1212113111=km-5ndmg"=1I01:11et=d operation'eavgoe or its rr,herztial egvivaie& The
tmdesigned certifies that snob zove:age is mforzz,and has uteri proof of same to the pzzait issuing ofd.
CHECK ONE: INSURANCE ® BD1W ❑ OTEEa 0 (6pee(fy':)
I exrf.fp,under fisepains and pe naf6er ofpajrrry, Sam the inform dors a$sur ezppFueterion is isle mid cornpldr
FIRM N.AMTs: tit ik ex OA? c;o PiMS LEC NG.: 027)(0 P)
Liens= , Sigas on-e LIC NO.:-2Z64tr1 Pc
wcgii=bk,ewer"range in the Zieeee a maniac-lre) Butt.TeL Na.. l1+ V7 (0V51
AMdress: Alt TeL Nil-:
*Per MGI.. n. 147,s.57-61,i wort requires Dept ofPublic Safety Lionise: Lie.No.
OWMCR'S INSURANCE WAIF I am aware that the.Liam does not have the liability num lee coverage naosally
required by law. By ray sigma=below,I hereby waive this re:gt-emoo>. I am the(r r--n one)0 owner ❑ owner's goat
Owner/A:eat
Ripa are Telephone Na TAT- : $
t f. c,pt-c-n Gey.)
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