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Home My WebLink AboutBLDE-23-000597 a16kCommonwealth of Official Use Only A.r JE _ Massachusetts Permit No. BLDE-23-000597 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:8/4/2022 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) 174 WINSLOW GRAY RD Owner or Tenant Fabricio DeCarvalho 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: Septic pump&alarm 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. 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 Tot 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 1 Totals: Detection/Alertine 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 Siens No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors 1 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 F SIMON IS Licensee: Michael F Simonis Signature LIC.NO.: 16862 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 1488, EAST DENNIS MA 026411488 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 1‘.1( sic 1v, ( _._, tcei vmoarc __.)°l'q/-111. (� /A 6/1piai 1 A 7- 10 ray.uscn hero ic- -s-rep. A;s CiCTdr- i 6 c s ET` - ,Yf-- RECEIVED -'_ �ae.lts official use Only _.I 2 of �S AUAU e7 n Permit No. .' -� �UsPartnwnE oil giro s`^�"`b Occupancy and Fee Checked t+ TENT BUILDING'- _ RD OF FIRE PREVENTION REGULATIONS [R 1/ 1 (leave blank) By. APPLICATION FOR PERMIT TOthe�PERF ELECTRICAL WORK All work to be performed in accordance with /a' ssachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATTDate: �'/3 ON) pector of Wires: City or Town of: /jp 07 v� To the arm d1Ielwork described below. By this application the undersigned gives notice of his or her intention to pert Location(Street&Number) , --74 la/ ` Telephone No. 1 Owner or Tenant T r' "`/ o Owner's Address No Imo- (Check Appropriate Box) Is this permit in conjunction with a building permit? Yes ❑ f c'ly�.=- .,,� Utility Authorization No. Purpose of Building S/�5�� Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters N v� Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity .-. Location and Nature of Proposed Elecnicsl Work: w, .. -, Ar 1-1 Z.e✓ / ' Z .--L.. be waive!, the I or o Wires. ) Cont, ion o the dim' : table 00.0 0' W No.of Recessed Luminaires No.of Cell.-Snap.(Paddle)Fans Transformers KVA KVA " Generators No.of Luminaire Outlets No.of Hot Tubs 1, i n Swimming loll ,1 d e 0 ,° d. o.o 'mergency g A No.of Luminaires ❑ Bette Units No.of Oil No.of Receptacle OutletsBurners FIRE ALARMS No.of Zones,o.o , - + ,n a, , lz No.of Switches No.of Gas Burners Initiating Devices '_= No.of Ranges No.of Air Cond. al No.of Alerting Devices Tons Heat Pump[Number I i Ton=._.._I No.of Self-Contained No.of Waste Disposers Totab: TKR' Detection/Alerting, Municipal �. No.of Dishwashers Space/Area Heating KW urs Connection 0 Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: HeatersKW Signs Ballasts No.of Devices or F.gdvaleat Telceommnnicatlons W No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or M t 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: 4/7/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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) 77--,-7-,At-�• r- .s- I certf fy,ander the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: -.4-e.- .t /L 2e6- is „„T:',, _ LIC.NO.: /G f 4,d Licensee: ,_.Ar-e./.5-/.,_z s./t Signature . ,/,.---,4-4 e- - LIC.NO.:. . 30 2 3P Of applicable,enter"exempt"in the license number line.) Bus.Tel.No.:.reg9-g5?9- X627 Address: / . O . '3FSG, /yP P S.• P•e"r"'cs., tie. '" V/ Alt.Tel.No.: *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. Own tune Telephone No. I PERMIT FEE:$ • 'O Signature