HomeMy WebLinkAboutBLDE-22-007372 • Official Use Only
Commonwealth of
Massachusetts Permit No. BLDE-22-007372
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:6/22/2022
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) 114 BERRY AVE
Owner or Tenant MEHL STEPHEN J Telephone No.
Owner's Address 114 BERRY AVENUE,WEST YARMOUTH, MA 02673
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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of solar PV system(12 Panels 4.8 KW)
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. Total No.of Alerting Devices
Ton
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 ❑ 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: Nathan A Ashe
Licensee: Nathan A Ashe Signature
LIC.l NO.: 21136
(If applicable,enter"exempt"in the license number line.)
Address: 166 Hunt Rd, Chelmsford MA 018243747 Bus.Tel No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.:
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 ❑ owner's agent.
Owner/Agent
Signature Telephone No.
PERMIT FEE:$150.00 I
6 b wf 3(
i �/
_ Commonwealth o/Maajachudettd Official Use�OJnlyy[
�' * = ( C 1,--7l 37/—
c lt�-�t cX Permit No.
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W . . ;2 -�`� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 07cy and Fee Checked)
al '— (leave blank)
> a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
W o All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
V Z Z( EASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (, -C (9099
W -, o City or Town of: i rr h To the Inspector of Wires:
this application the undersigned giv notice of his or her intention to perform the electrical work described below.
RI ation(Street&Number) l I LI 9 _RC
Owner or Tenant AiegIettl:1 ► (� Telephone No.mg 7T7-/Qy
Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building noel,( - Utility Authorization No. '
Existing Service /�O Amps // �y� Volts Overhead Er Undgrd❑ No.of Meters I
�V g
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity ��((
Locati and Nature of Proposed Electrical Work: Ins-1._'a( Ginn (it mewler,
7holaoli-n is QOlnr s 9 r:� ; /� pef�AS � Kul
9 Completion of the following table may be waived by the Inspector of Wires.
No.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 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 Detection and
No.of Switches No.of Gas Burners Initiating Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
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 ❑
Connection Other
No.of Dryers Heating Appliances KW SecNo o Systems:*
Devices or Equivalent
No.of Water No.of No.of
Heaters KW Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
' e60
� Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Valu o Ical Work: (When required by municipal policy.)
Work to Start: `��I ���;, Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGES. 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 cove a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:)
I certify, under t p Ws and pen hies of perju75uv'\ruv\
,that the information o thisf pplication is true and complet .
FIRM NAME: _ k`a-E-i Or LIC.NO.: 1
Licensee: ; Signature LIC.NO.:
(If applicable enter '!exempt"i t eliccense number 1 e L Bus.Tel.No.• 3.n ".Address: 695. gigs SIUldis7 SlJ, lour it t Mg , 7(1)0 Alt.Tel.No.:
*Per M.G.L.c. 147,s157-61,security work requires Department 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
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
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