HomeMy WebLinkAboutBLDE-22-003127 Commonwealth of Official Use Only
Massachusetts
Permit No. BLDE-22-003127
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:12/1/2021
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) 28 SIERRA WAY
Owner or Tenant Wayne Curly 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 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: 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 8.5
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
Initiatine Devices
No.of Ranges No.of Air Cond. Ton l No.of Alerting Devices
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 ❑ 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 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: Michael R Devine
Licensee: Michael R Devine Signature LIC.NO.: 21319
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:20 LITTLE MICAJAH PND RD, PLYMOUTH MA 02360 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
tig. 11174 74 F--t ( -c NOT- CoNlW-zi A)
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" ` Commonwealth of'aeanchueslfa Official Use Only
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,---;:ii-"=ft cc�� cc77 nn Permit No.
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,a1,:... F �(Js/vartment o`}in Jirvicse
t Occupancy and Fee Checked
V BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
,r.! 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:
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.
yLocation(Street&Number) /f 5 le-"(` y\).4....y
_ Owner or Tenant � ,I yam_ Lt,.{�1A, I Telephone No. ao7- EQ$ yob
Owner's Address r She_'t-.,
Is this permit in conjunction with a building rmit? Yes 0 No
(Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service f ()i . Amps 112 /Z`'t, 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 F,lectrical Work: ••V> }�sk,' a,n ei,S Lk, y,,___4,06--
W i Th �rA 0. ;-(- C)cc v;`f' n Self Si,;4 1-.
to ay Completion of the mbe waived by the Inspector of Wires.
tlt No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total
`'r Transformers KVA
't No.of Luminaire Outlets No.of Hot Tubs Generators '$ , ' KVA
r`t
t' No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
grnd. and. ❑ Battery Units
`` No.of Receptacle Outlets No.of Oil Burners
FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners 'No.of Detection and
II<< Initiating Devices
Tota
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump umber}Tons 1KW 'No.of Self-Contained
Totals; Detection/AlertIn Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection r-1
other
No.of Dryers Heating Appliances KW Security Systems:*
K
No.of Water No.of No.of Devices or Equivalent
Heaters ' No.of Data Wiring:
Signs 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 ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Stan:`l a- 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
_......—_
dersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
;.y ..._.,...._.._._, _ HECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
r----
- I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete.
RM NAME:
censee: ynr c . LIC.NO.:
Signature ,/>' LIC.NO.: 13) 7—
G r applicable,ent r"excerpt"in the license numbe line
* dress: �;] I i Jam), Q� -) 11,140.-1.3-1-).-•,� 9 ty-a`"`'r
i !' cry �r� Bus.TeL No.: Se
c.No.
1 , 'tress:
c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.L,el.No.:s�7$ �y 6 )6�j
_ , 1 c, -.,,O ERS INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance overage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one y
1 ` :, . - - N,ner/Agent owner ■ owner's a.ent.
' Snature Telephone No.
_ PERMIT FEE:S