HomeMy WebLinkAboutBLDE-22-005989 Commonwealth of Official Use Only
i Massachusetts Permit No. BLDE-22-005989
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:4/19/2022
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) 60 ICE HOUSE RD
Owner or Tenant Alan Shawcross Telephone No.
Owner's Address 60 ICE HOUSE RD, SOUTH YARMOUTH, MA 02664-4112
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: Remodel basement.
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
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 ❑ 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 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: PETER PETO
Licensee: Peter Peto Signature LIC.NO.: 14763
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 132 Wintergreen Ln, Brewster MA 026312258 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:$75.00
aLr ��2u`
J . 0 o
G E I V AI; , el Mem ekiesils Official Use Only
r.,
A 9i i.,PR 19 2022 ►i, 11 .� Permit No. g�'
•‘. . BOARD OFF - �Y d Fee Checked
,,, _ - PREVENTION REGULATIONS [Rev, l/07j ------
BUILDING DEPARTMENT (leaveb c)
' — = e. .— 'e R PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with tie Massachusetts Electrical Co*( ).327 12.00
(PLE4SE PRINT IN INK OR TYP INFORMA NI Date: la 2 --
City or Tows o1 l al/tat, To the l o Wires:
Bythis the undersigned �~� ot her intention to IS': it
L ecadsa(Street&N ) C0 (C e vu. U.s� •�j wort described Cfll l below.Owner or Tenant / Skc.1.) CISCS5 T No.
Owner's Address
s Ise*permit 5
0 Peg**of �ing I`t�-s�Gl/'�c�i �`� Yes 0 No >:1 (Check Asti Bea)
Utility Automation No.
i Existing Service Amps I Volts Overhead❑ Uadgrd 0 No.of Meters
J lew Semler Amps / Volts Overhead 0 turd❑ No.of Meters �-
Number of Feeders and Asupatity
Work: 3 ckSeIV�'tet44 1, o
lion and Nature of Proposed il¢,,,,,
Two; kEi� r
� j 'rail ivaid' t:oiwietione dgefelliw leek� be livered by the Impactor ef
No.of Recessed Luminaires No.of Cent-Susp,(Paddle)Fans Tro.of Toad
aders if VA
N..of Lumbar*()Wets No.of Hot Tubs Generators KVA
No.of Lo Peeltad e ❑ ! ❑ Vaits fY> t*
No.of Receptacle Outlets No.of OR Burners FIRE ALARMS � of Zones
No.ofS�ches No.off Burners .No,t h`d
Wattle'Devices
' Total
No.of Ranges No.of Air Con&,
Tons Llio.io.of Alert Devices
No.of Waste 1$lamer f rosTotaim _, v_'No of Self-Contained
eviees
No.of Dishwashers Space/Area(Resting KW Local QDoectionalimies ❑ Other
No.of Dryers HeatingA
No.o[w. irpWst of N KW Nob of .or' a dvalent
itters Kw f Data Whinip
Signs Ballasts No.of Dcv . or _,( , - t
No.Hydromessage Bathtubs No.of Meters Total HP T a -' . t
OTHER: Attack Na of +"�.- or
Estins tf Value of Electrical Work ee to a►l detail(timbre(eras revoked by Inspector ofWires
Work to stare: (what required by municipal policy.)
INSURANCE COVERAGE: Unless ons��a�ao�with MEC Rule 10,ant!upon�,
the licensee provides proof at liability insurance including permit four the performance of electrical work may�e unless
mooed certifies that such coverage is in force,and ins exhibitedor equivalent. The
CHECK ONE: INSURANCE ►: BOND OTHER (Specify:
of to the permit issuing office.
Imo►,�,: ��, ❑ ❑ (Spccifv:) -^
FIRM NAME: r 'C; ��as this eta water
Licensee: . � � -+� d � LIG NO.: 1�(��,�
Ueeuee bk. �m � -"IPP LIC.NO.:
Adtlr+esfr t, =5 ( /' J R .►
Bea,Toe.No.:
'Paer M.G.L.c. l47,s S?-6h,sectaity work )- AK Tel.No.-
OWNER'S INSURANCE WAIVER: I am aware that Hof not l the liabilityLie.No.
rance coverage normal
required by law. By my signature below I hereby waive this requirement. 1 am the(check one)❑owner 0 eh ner s aatetu
Signature Telephone No. I PERMIT FEE:$