HomeMy WebLinkAboutBLDE-22-001446 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-001446
• 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•9/14/2021
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) 4 STRATFORD LN
Owner or Tenant OBRIEN VIRGINIA C Telephone No.
Owner's Address 4 STRATFORD LN,YARMOUTH PORT, MA 02675-1545
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: Take over job.Walk through to see where it was left by other electrician.
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
Initiating Devices
No.of Ranges No.of Air Cond. ,Tl,00nal No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained
Totals: Detection/Alerting 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 Eauivalent
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 ofperjury,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: $50.00
OfiZI c ) / i
•
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/ G' O'is Use Only
arinsanc ,mssi 47. —,i7"-44&
and Fee Ci-tecke‘i
BOARD OF FF. E PREVENTION R=GU! t NS Rev.i._:v!;y Feetie :aa:K`
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Al work to be ezfor.e^in tcco °.i=ce with the N-IPmsxr-',ses!:e'c'T.riml Code_ ^. C 527(.",101Z..12.00
(PLEASE?Rt T ll INK OR YPR LL ` RR Q4 LO CY Date: i 0�QQr21
City or Town of: ji--i 7OLCij o The Inspector of Wires:
By this appIit ion the;mciersigred gives notice ofIlls _or her to t:on to per orme elecukal work described teio .
Location(Street&Number) ' l "I Cc'`rbirtA Lori E:•
Owner or Tenant V t 6i 11 4 Ct. 0` Orr'Pei Telephone No.
Owner's Address 4 , 7fl [ 0 /7I t � //�7{lU it �i
Is this permit in conjunction with a building permit? Yes No : (Check Appropriate Box)
Purpose of Building ;. Authorization No.
•
Existing Service amps Volts Over head - U'uderd_ No.of Meters
New Service Amps Volts Over!ezd i ud e No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Ove )O//( 1.61214/7 h izbre a 1
1�,Spe.Crr� it )ii.1,51,1 tA)ho t- (1,O -ncr _e V'C ter C../Oki11t ,
Com Jle.ian of rite ia.io inz:co le m.oy be w'd.r.:e.4 the.?soe::Dr of Dims.
Luminaires ::No.of Ceti.-Suis Fans :No.r °f Total
No.of Recessed Ltun�i P•�- ,Transformers KVa
No.of Luminaire Outlets No.of Hot Tubs 1 Generators KZ A
Above — In- ;No.ofmergency Luing
,No.of Luminaires Swiemmiag Pool ernd_ — and. L_..:1 Battery Smits
!No.of Receptacle Outlets r 'No.of Oil Burners !FIRE.LARD No.of Zones
No.of Detection and
No.of Switches ;•No.of Gas Burners Initiating.Devices
!No.of Ranges INo.of Air Cond.
To
.:!Co.of alerting Devices
i .
Heat Pump?Number !Tons :KW No.of See-Contain' ed
No.of Waste Disposers Totals:: ➢etectiaaratertiva Devices
3uuicipal
lNo.of Dishwashers (Space/area Heating KW 'tel E-` Connection —= Other
`No.of Dryers 'Heating appliance; Kms' 'Security Systems:*
No.of$evict or Equivalent
!No.of Water No.of No.of Data Wirings
Heaters S. Ba'•la,�s No.of Devices or Eeurya etit
'No.Hydromassage Bathtube No.of Motors Total HP Telecommunications u''ering.
No.of Devices or Eauivalent •
OTHER:
• =Mach oddli ions 1 derail.fd s red,or ccs re fr a 0.-M_'r-spec-or Of 7/rel.
Estimated Value of Elecaica Work: r.e rep__er by=: cera_policy.;.
'Work to Start: insvec lor_s to be r ^::este..it acrcrda tce withMEC Rule 'i:,air:r'..7or :oi.:plefon.
INSURANCE COVERAGE: Unless wal-gee by.:a Q .iiia for theJerfc-::::ance eeleaTical work tray Issue ur.ess
the licensee provides proof of isci iity insmnce licit .:"completed operaron"coverage or its s:bsi. r i e.°u a.ien. The
dersigned ce +es thaz surf cove is i=tree,and:.:mss ex=: bled :,oc of sue tc the p _it issuing office.
C_iCK ONE: TNSL ANC.r�'; BOND 07—ER ;Specify•;
I certify,under toamts and-penalties of oer, -a7,k=the:.'zforerroan on this aar&non is a•.se and corrwie a
HAM NAME: a,,,:/-)., e C z. - cs' ' LIC.N t}.: r 1r�
04
Licensee: 3 Jkz..'-(L C..e=5.=t+c Sigaarur e ,J r° :.-L S',fi .'t LIC.NO.:..57 66,v2E
fcpplicable,er=a "eremrr"•ntihe::cense nut er ir.e., Bus_Tel.No.: rni St', �
address: ‘4 ELY i�c�rt.� l�f i c .-arc •-t-- c,:.,;2_7071 C A..1t.Tei.No.:
*Perc. 147,s. 7 i Dec:�zme_c.,f?:hl c'Safety icense: L.c. �...'`
�l.G.:.. � -E E;SCC'z^�'work?EC�:1 c5�.. ;' '�':.'• �„'t 37; i
OWNER'S ENSL'RANCE WAIVER: i L' aware that� Li -i2e-GC_-''G?/u-;�the
2L:ii% i:SL.":e'](.."CCVCs�e IIo-?:2i:y
required by law. 3;%my ssa. re'below, :ere✓y valve this res.. e'^_ent -a=the'c te:.kk one) r ownerow- 'S acei.:..
/Agent •
Owner
et ire Telephone No. v s PER fi��.�: S __