HomeMy WebLinkAboutBLDE-22-001128 co, Commonwealth of official Use Only
Massachusetts Permit No. BLDE-22-001128
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/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:8/30/2021
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) 61 GUNWALE WAY
Owner or Tenant GUERIN NICHOLAS A Telephone No.
Owner's Address '?''r itedk SR&LUCINDA A, 3 CONDON DR, SPENCER, MA 01562
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Upgrade service
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
Tons
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 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: JOHN C BURKE
Licensee: John C Burke Signature LIC.NO.: 50364
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:45 DIX ROAD EXT,WOBURN MA 018016104 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. I
/3/ I PERMIT FEE: $50.00
L9-t (9,_. / (7i k .
14 Official Use Only
'" . a. `' "''fi edv t 7 ''e-� Permit No. C Z 2�
ici-
NOccupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 clave blame)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
r\, 1 All work to be pied in accedence with the Massachusetts Electrical Code(MEC),52 CMR 12.00
�J (PLEASE PRINT IN INK OR Tl'P ALL INFORMATION) Date: �/,30/,1/
City or Town of: g/3-n,.i� P To the Inspector of WIf�s:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
V Location(Street&Number) ( / 6 Li/0 &AI 4 41-14 Y
Owner or Tenant cielj 7-,) 1/L v,ErC r'r✓ Telephone No. 7 2S/- ;27.)
N._, Owner's Address _7T 3 S .
Is this permit In conjunction with a
permit? Yes 0 No Er (Check Appropriate Box)
Purpose of Building 5;45 /r / '-i I/ Utility Authorization No.
Existing Service /U- Amps / //Sv/°Volts Overhead 0 Undgrd lir No.of Meters _.L
Nalgligt /DU Amps / /.279 b Vohs Overhead 0 Undgrd L No.of Meters
Number of Feeders and=opacity
Location and Nature of Proposed Electrical Work:// /is if e.&i U. .( fz ,7,.., c>4
es "-i ) ecn,jsd (J {i
. .. S"cclfr f C r/a Ce_ .Sc 17 vte /j
C4X Qfthelel tablenegy be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CsO.-Suer,(Paddle)Fans Tranosformers TKVA
(1. No.of Luminaire Oath= No.of Hot Tubs Generators KVA
No.of Luminaires swimmitsPoolAbove0 I 0 nom U c'ugating
s No.of Receptacle Outlets Na of Oil Burners FIRE ALARMS No.of Zones
f Detection and
No.of Switches No.of Gas Burners No.Initiating Devices
11, No.of Ranges No.of Mr Cond. T= No.of Alerting Devices
No.of Waste Disposers NTOals: -per ITS. Imo!. , �� `
Devices
No.of Dishwashers Space/Area Heating KW Local 0 M 0 Other
No.of Dryers Heating Appliances KW 'Security Sy ,*
No,of Devices or Eautvolent
Na of was �, Signe Ballasts No
No,erg N Data
Wiring:ofDevicta or • • t
No.Rydre Bathtub* No.of Motors Total HP No. orlecomm , - u ' " t
OTHER:
Estimated Value of E - Work: ,S 0 uu.
co Attach dAaail{f deem oras required by the Inspector of ii7res.
(When required by municipal policy.)
Work to Start: t -- Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE •VERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee inevides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such co is in force,and has exhibited proof of same to the permit issuing office,
CHECK ONE: INSURANCEND 0 OTHER 0 (Specifr)
I •ander the pains and penalties ofpesjary,that the Wise scion on this application is true and complete.
FIRM NAME: LIC.NO.:
L iceasee 6/it/Jci,t_et
Signature 9 LIC.NO.:CS`a 4-c "/
(!fapp/kob/a,enter"eXtaspt"in the licenseriser IbceI Bus.Tel No,:
Address: i•& D 2
k dr.-- ) 4_7,,(17- 0 ,4-1, p-t/fiO/Pe Alt.Tel.No.:/ 7 S/ --78-f— p 7
*Per M.O.L.c. 147,s.57-61,security work requires-I�artment 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
Owrequired n r by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent.
Signature Tolenhene NR. I PERMIT FEE:$