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Home My WebLink AboutBLDE-22-001702 o' Commonwealth of Official Use Only f'E Massachusetts Permit No. BLDE-22-001702 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•9/24/2021 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) 23 SCALLOP RD Owner or Tenant SZCZUROWSKI ANDREW Telephone No. Owner's Address 298 BEACON ST#8, BOSTON, MA 02116 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: Site visit 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 No.of Ranges No.of Air Cond. Total 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 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 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: DANIEL E DICESARE Licensee: Daniel E Dicesare Signature LIC.NO.: 21275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 ELK RUN, MIDDLEBORO MA 023463065 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: $50.00 CUig 7Th t wi i f lq;SreiS "00,1 . �.\ e os 49' a, ae3u.3aith �c�o ci2 Jse ti• c*_ 5(._.—('' _-I lY//Sd..yL fF C' /7 ?emit:No.S-'-7-1----`-t O epezesnzem e /� _ Occ'ur and Fee CI-L BOARD OF FIRE PREVENTION REGU IONS (Rev.�' ks,dr ;E- 1 (leave b�kj APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be cued=acxrd ce with the Messach cern sec=mi C (NEC),527 CNS.1200 PLr 4 E PRiNTLV Ila OR TYPE ALL DT Date: GI 1(o kit 1 City or Town of: ! >far rhOU 1 - Ta the I svector of Wires: gives=C- - "e= -e�� perform the electrical work described below. By this app+:ic on the tinders ice or. s or; e or Location(Street&Number) 3 Sea I tt, R.00Id Telephone No. Owner or Tenant Owner's Address Sd,eV ! — Is this permit in conlurtrtiaa with a build�a permit? No (Check Appropriate Box)Yes — — .Purpose of Building I Utility gthorizaflon No. Existing Service Amps Volts Overheari . I ndgrd No.of Meters Volts Overhead— I.ind�d No.of Meters New Service Amps Number of Feeders and opacity Location and Nature of Proposed Electrical Work: Si I.C, '/ISI f 1 Comrierion ofto fo:Loy:ins:abie may be•.,aired by the irsoee nor of Wires. •No.of Total !No.of Recessed Lnntmores ; INo.of Ceti/Susi).Waddle)Fans ;Transformers KVA iNo.of Luminaire Outlets !No.of Hot Tubs !Generators !No.of t merb ncy Ztntmn No.of Luminaires S innniina Fool d.e _aTnd. — I;Battery ni s — •No.of Receptacle Outlets No.of Oil Burners !FERE ALARMS Iiia.of Tones I- ! No.of Detection and 1 No.of Switches No.of Gas Burners InitiatiCt Devices Total !No.of Ranger i o.of Air Coad- Tons I_!°.of Alerting Devices ;�o.of Waste Disposers i Hea P Totals:!Nutuber !Tons 'KW No.of Se1f-Coatamed =DetectiogiA.lerti Devices `• Municipal ; Other • I No.of Dishwashers ;Space!A_rea Heating KW ;Local[ Connection = sanity' ystems:" No of Dryers :$eating Appiiano Kms. No.-of Devices or Equivalent j, K• (,. No.of No. .Data Wiring: No.o.of Water ! Heaters Sys No.of Devices or Equivalent No.Hydrousassage BathtuosTel No.ofDeices5 mval No.of Motors Total HPo-of nevices orraa:waieut. 'OTHER: • ?ach aderional derail ifd sire4 or as required O:rhe ns for of.fres. Esarnazed Value of Elecuical Work: :,When required by munic.bai poli y.) a.....:_::2:Ce with NEC Rule IC,and upon.:oicp e_o n. Work to Start: _:�-peceojs:c�:,:.: �es_ed L._ - -elect—.7 .1 w.,_ INSURANCE COVERCOVERAGE; T.:niess -vee by owner,;lc permit or ,e tie.- e or -+."'.1 work may issue.`:es - etee opera_on=coverage or its su5t t?l eq;ii-valem. �e licensee provides proof o=1ab_�;ti i-±s��`�._:�=� `co_p _ - The ,3� has e�.Iblted;Tool of same the permit issuing office. ;';sem-Si�ieci w�t�.e5 that SkCL'j COV �e is--v_....;E::_ _ . C EcK ONE: INSUR CE ;s!; BOND _ 'O I. : (Spec ;:) w I cerrifj,under the pains an fps calves of perjury,_ =the ir1 orrrror on this appticadon is true and comp/4,7P.. ( ,, FIRM NAME: q.c:t � e'.�c_ri c c L. LIC.IO.:CI�oC ::ter` "1 K;%E L `' ; f.-:LAIC Siantriir8 2 & &./.>7:1.--......"-z, LIC.NO.: }i 6,.4, 4-- t Licensee: 1 l� � Bus.Tel.�l0-:,j 5'i 13S.•5 o�--,C. n'.^.-Dpt �enter"=mDr"Cyt to license number!ire.,' ;'R4 aLe K J J.4t36,`..ism.—^ A. .-syv LTel.No.: address: d ;. De,`--=n-of ri^i:.Safety"V:>:..icerse: Laic.No. C``c"` 13 )5 'aper M.G.L.C. i-"r7;5.57-61_SeCtsrz�J work'eC.i-_e5 —•.`-r - does -TiS��theliability insurance COv_e:�e AOI'Sie::v OWNER'S ENSL'RANCE SGAIVER I am aware':a•: ensee aces no_ ns wne waive. requirement n am the(c_eck one)_o I.....;owr.e s age- - required by law. By u�5y:a-..:T�.below, �'.�.:^J�'i:%% this: .:::1':'e� - � RT Si /Agent gnaTie owe o i PEFSE: S ,..5D isseature