HomeMy WebLinkAboutBLDE-22-001893 _ Commonwealth of Official Use Only
Massachusetts
Permit No. BLDE-22-001893
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:10/4/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 42 GORDON LN
Owner or Tenant FRATUS JUDY G Telephone No.
Owner's Address 42 GORDON LN,YARMOUTH PORT, MA 02675-1815
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 (14 Panels 4.97 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 0 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. Total No.of Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
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 Ballasts Data Wiring:
Heaters Siens No.of Devices or Eauivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Eauivalent
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: Nathan A Ashe
Licensee: Nathan A Ashe Signature LIC.NO.: 21136
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 166 Hunt Rd, Chelmsford MA 018243747 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: $150.00
01, ti( / Prir iaecJ
1 Commonwealth o`//laesadaeetfe Official Use Onl
'' >� _'i Permit No.'' #2.2. ( S 113
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2epartnuent of.Jire&ry
Occupancy and Fee Checked
a,- 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.
(PLEASE PRINT IN INK OR E ALL INFO ON) Date: 1 -D._9-I . ---4
City or Town of: (V f l( To the Inspector of Wires:
By this application the undersignednotice of his or her intention to perform the electrical work described below.
Location(Street&Number) t— lord 6 r rte.
Owner or Tenant (Jd (`t"h T rcit,cry )S Telephone No. SOl(,34 Q X350'
Owner's Address SGkAk-12, OV
Is this permit in conjunction with a building permit? Yes.0. No ❑ (Check Appropriate Box)
Purpose of Building, C•1�W e r
I � � Utility Authorization No.
Existing Service ICS Amps fa-IOVolts 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_gt53r I I 11/4--1 (CDC)-t— me n-- -.0
Q,vj- ,S, LA .6'I _ -C_, )
Completion of afollowin&table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Tf T
Transformers KVAVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad. Battery_Units
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
No.of Ranges No.of Air Cond. Total Tons 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❑Municiponnectional 0 other
C
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:
evq 01.] Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value o El "cal Work: (When required by municipal policy.)
Work to Start: 1 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C GE: 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 cov a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCFBOND 0 OTHER 0 (Specify:)
FIRM NAME:tih�Y —and penalties
of I 1 l f i, I I the information on this application is true and complete.
��Ll LIC.NO.:
{1,, _
Licensee: L(Jl,1 ' K.(iT\ hP, Signature ..itillililliWarznim6. - _ LIC.NO.: � t I (019-
(Ifapplicab¢ce��((er"exemp "in the license number line) IIIIMM��"
IC J tAs- �P,0 1 aL1.(t'1 ,illU4 it ` :' Bus.TeL No.•
Address: Alt.TeL No.: cl
*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 0 owner's agent.
Owner/Agent I
Signature Telephone No. I PERMIT FEE:$
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