HomeMy WebLinkAboutBLDE-21-005355 �. Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-005355
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:3/18/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice or his or her intention to pertorm the electrical work described below.
Location(Street&Number) 54 DAVIS RD
Owner or Tenant Lori Rogers Telephone No.
Owner's Address 54 DAVIS RD, SOUTH YARMOUTH, MA 02664-4102
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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement HVAC.
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. ppd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ 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 Siens 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: JAMES M VENUTI
Licensee: James M Venuti Signature LIC.NO.: 15798
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:30 JOSIAHS PATH,W BARNSTABLE MA 026681340 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) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
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ta_-- ;' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
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 INFO 1A TION) Date: 31 i J /c.
City or Town of: Ctr/koUTo the Inspector of Wires.
By this application the undersigned grs notice of his or her intention to perform the electrical work described below.
Location(Street& Number) 5Y Qc V+S IeOGJ-
D
Owner or Tenant LO( leAcy 6 Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No p. (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps I Volts 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: e i I ..
Completion of the following table may be waived by the ins ctor of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o'° "'tel
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 INo.of Zones 1
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges Total
1; No.of Air Cond. Tons No.of Alerting Devices
'eat 'ump `um' r ons ` ` `o.o e - ontam
No.of Waste Disposers
Totals: ,Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipa ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Waters KW No.of No.of Data Wiring:
eaterSigns Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wring:
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: 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 cove ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:)
I certify,under thins and penalties,of/perjury, that the information on this application is true and complete
FIRM NAME: JQnrtV
c-S M . c.� f(-? eIc*i(- -- , L1C. NO.: /-}157T
Licensee: J .-,enc-S /14 Vc-e7 Signature LIC. NO.:
(If applicable, enter "exempt"in the license number line) f, Tel. No.:56i"/ZT-7t5
ao
Address: 3r) 3-0.--.›i•=L-1s V-9-111 LAI . tames,7 5:1-e l:-- /14 4 0 2-G6 5 Alt.Tel.No.:5-0g-6,Y '-$136,F
'Per M.G.L. c. 147, s 57-61, security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: 1 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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. l PERMIT FEE: $ I
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