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Home My WebLink AboutBLDE-22-000179 \,1 Commonwealth of Official Use Only o ANN Massachusetts Permit No. BLDE-22-000179 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:7/12/2021 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) 11 MEADOWBROOK RD .77 21v4_G 2/ b Owner or Tenant PETRILLO MICHAEL J TRS Telephone No. Owner's Address ''' i. . ;t- ;' VITRS,440 EAST ST, MANSFIELD, MA 02048 Is this permit in conjdn '. ivirh a btattdhig 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: Residential wiring. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 2 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 6 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 5 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton 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 ❑ Municipal ❑ 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 ❑ OTHER 0 (Specify:) 17t f 11(0 6 9 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. u FIRM NAME: SHAWN A SOUZA Licensee: Shawn A Souza Signature LIC.NO.: 39768 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:31 LAKE DR, PLYMOUTH MA 023605648 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. (PERMIT FEE:$75.00 I P.014(41 71 l2t 14 W. t—(61)9't (Mo xi-u94 Q � 4 9f 764 ;— 6 RECEIVED - - ,S ` JUL 1 ? 2021 .ado 0 Official Use Only at (! h o` ire Permit No. DING-D DEPARTMENT E N Te Occupancy and Fee Checked} - = PREVENTION REGULATIONS [Rev. 1/071 (leave blank) a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Nof All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 NI (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 0 " i 1 I Z..1tt2-O2- 41 City or Town of: lei ri i'1Dtl h To the Inspector of Wires: By this application the undersigned gives no ce of his or her intention to perform the electrical work described below. $1 Location(Street do Number) �, I ( ,pp4 go , Owner or Tenant NI id ct4 .P. h.{ it O Telephone No. Owner's Address al Is this permit in conjunction with a building permit? Yes `7 No 0 (Check Appropriate Box) 44, Purpose of Building cgs i cir irA-- CN Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps /: Volts Overhead El Undgrd❑ No.of Meters gai Number of Feeders and'Aty Location and Nature of Proposed Electrical Work: Completion of thefollowingtable mr be waived by the Inc for of Wires. tit No.of Recessed Luminaires Z No.of CeiL-Sasp.(Paddle)Fans Transformers KT VGA! C No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires2 Swimming Poor Above 0 In ❑ No.of Emergency Lighting mil . grad. Battery Units No.of Receptacle Outlets 6, No.of Oli Burners FIRE ALARMS No.of Zones z. No.of Switches ,j Na.of Gas Burners No.of Detection and Initiating Devices 11wr No.of Ranges No.of Air Cond. Tom No.of Alerting Devices No.of Waste nbpceers Pump Number„Tons KW 'No.of Self-Contained Totals: -------- .w..__ . .... DletectkNAle , Devices No.of Dishwashers Space/Area HeatingKW Mae y p Load❑ Connection 0 Other No of Dryers Heating Appliances KW Securityystems:, No.of Devices or Equivalent No.of Water KW No.of No.of Data W Heaters Signs Ballasts No.ofDevicesorEquivalent No.Hydromasaage Bathtubs No.of Motors Total HP T mmnaic a ons fi cg: No.of Davies or F,qutv7slent OTHER: s 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 5Q BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: E 3e170? Licensee: ( > g IA2 q signature LiC.NO.: E 39-749 (If applicable,enter"exempt"in the license number line.) 0 Bus Tel.No.: Address' Lake ake ;D1 PI fF Alt.TeL Na.: *Per M.G.L.c. 147,s.57-61,security wor requires Department of Public Safety"S"License. Lic.e c o. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have thealiability insurance coverage normally required by law. By my signature below,I hereby waive this requirement.lot the(check one)❑owner lowner's agent. Owner/Agent t PERMIT FEE:$ Sure Telephone No.