HomeMy WebLinkAboutBLDE-22-003148 �.%• Commonwealth of Official Use Only
� �� Massachusetts Permit No. BLDE-22-003148
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:12/2/2021
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) 24 KATES PATH VILLAGE
Owner or Tenant Roger Deromedi Telephone No.
Owner's Address
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: Kitchen renovations
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 0 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/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. '/' �� �1��
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) f" 1
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Matthew P Dennen
Licensee: Matthew P Dennen Signature LIC.NO.: 21609
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:PO BOX 88, BUZZARDS BAY MA 025320088 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
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o c N; BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]• �
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Lij '' - ! • PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
e 1 v All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12,00
L ! , ASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 12/1/21
Lft J T Cityor Town of: YARMOUTH
mTo the Inspector of Wires:
is application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 24 Kate's Path
Owner or Tenant Roger Deromedi Telephone No,
Owner's Address 24 Kate's Path
Is this permit in conjunction with a building permit? Yes n No n (Check Appropriate Box)
Purpose of Building Residential Home Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
New Service Amps / Volts Overhead n Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of lights,plugs,outlets for kitchen renovation
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
Above El
❑ No.of Emergency Lighting
No.of Luminaires Swimming Pool
grad. grad. 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. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons Icy_ No.of Self-Contained
Totals: "" Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Co nnectio niection 0 Other, '
Co
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
No.of No.of
Heaters KW Signs Ballasts Datao.of Vices 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: 2,500.00
(When11/28/21 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 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on placation is true and complete.
FIRM NAME: Commercial Electrical Solutions Inc. LIC.NO.: 21609-A
Licensee: Matthew Dennen Signature 1G LIC.NO,: 12687-B
(If applicable,enter"exempt"in the license number line.) �� Bus.Tel.No.; 508-388-6169
Address: P.O. Box 88 Buzzards Bay, MA 02532
T*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By 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 PERMIT FEE:$ 75.00
wendy@cesinc.biz