HomeMy WebLinkAboutBLDE-23-000522 ' 13 Commonwealth of Official Use Only
' ' Massachusetts Permit No. BLDE-23-000522
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:8/2/2022
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) 10 QUARTERMASTER ROW
Owner or Tenant DEANDRADE GUILHERME A Telephone No.
Owner's Address DEANDRADE LEONICE Z, 10 QUARTERMASTER ROW, SOUTH YARMOUTH, MA 02664
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 ❑ 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: Air handler(Attic), heat pump, &receptacle.
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
fiend. grnd. Battery Units
No.of Receptacle Outlets 1 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. 1 Totalo No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: 1 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 SiEns No.of Devices or Eauivalent
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 perjmy,that the information on this application is true and complete.
FIRM NAME: ADAIR MARTINS ELECTRICAN
Licensee: Adair Martins Signature LIC.NO.: 55688
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:215 Palomino Drive, Barnstable Ma 02630 Alt.Tel.No.: 5088156173
*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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
Rs:A. 10/24,(„7/ ..........„
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BUILDING D PA' BOAR BY,_ _ .�,. D OF FIREEVf:NTION REGULATIONS OCcltpancY and Fee Checked
8 APPLIC1AI gTiON FOR PERMIT TO PERFORev.Iro7,C leave blank —'�--
k to be performed in accordance with the Massachusetts Electrical CM ALM 527 CMR 12.00
WORK
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of: Date: p
• By this application the un of:��givYA�RceMOUT N�Uon to ' To the 1
ector workf Wires:
Location(Street&Number) () ale4. ,�.e r.� , perform the electrical described below.
Owner or Tenant .l11 tTt.J rY1
rob_o(2 /Li A- 01; 64
Owner's Address elephone No.
is this permit in conjunction with a building permit? Yea
purpose of Building `QQ, � A ❑ No ❑ (Check Appropriate Box)
� Existing Service A Utility Anlhorizatton No.
m� / Volts
—""tiet "'-- Overhead❑ Undgrd 0Na of Meters
j{i
ppadty Volts Overhead❑ Undgrd g ❑ No.of Meters _
Number of Feeders and Am
, lion and Nature of Proposed Electrical Work:
e` � i d GL 1-4 Dt
lb
No.of Recessed Coat letion o the ollaw table:, be Luminaires Na of Cdl.,Sap,(Paddle)Fans tivea►b the/ for a Wires.
�ti 1�1a ofo,o
Luminaire Outlets Transformers KA
`1 Na of Hot Tubs
4• Na of Luminaires • Generators KVA
Swimming Pool � de 0 n- 'o.o 'mergency
Na of Receptacle Outlets ❑ Bette Units °g
-,: No.of Oil Burners
Na of Switches No.of Zones
l t, No.of Gas Burners.
a Inidatin Devices
No.of r Cond.
U'
Na of Waste Disposers
'eat nip `um r Tons , , No.
o•of Alerting Devices
cos on T1
Na of Dishwashers Alertin' Devices
washers Space/Area Heating KW DLocal W'nn t�1
Na of Dryers HeatingA Connection ❑ Other
'o.o 'a Appliances ICW stems:
No.of Devices or '
Na AydroHca KW o•S 'a Dogmata
to Data Wiring: nivalent
massage Bathtubs No.of Motors Na of Devices or ,uivaient
OTHER: Total HP a mmu gg
Na of Devices or ; .uivaleot
Estimated Value 1 Attach additional detail ifdesired,or as required by the I
Work to start: of�l Work:
o2a2 (When required by municipal policy.) t►apectorofW►tes.
INSURANCE C VE inspections to be requested in accordance with
the',licensee GE: Unless waived by the owner,no permit for the MEC Rule 10,and
provides pmof of Performance of eln completion.
uneecensed certifies thato liability insurance including"completed operation" electrical work may lent unless
covefage is in force,and has exhibited proofof�to theeor its substantial office.uivalent• The
CHECK ONE: INSURANCE (�'
I lK ONE:
the BOND 0 OTHER ❑ (Specify:)
permit issuing
FIRM NAME: pinseve and pe a ofpernry,that the info►maton on
Fusee: ',�T -�2 this t+ppiicaaon is true and complete
" ' LIC.N(lfapplicable enter Signature O•'---=� ;�
Address: Pt in the license n ber line.)
Nam_LIC.NO.: �`�
•Per M.G.L.c. s.57 1r ¢ �lR Bus.TeL No.. — --_.
O�'1'NER. c. 147, securr�y work �— S�f 1-3
INSURANCE WAIVER: I amr aware Department of Public Safety"S"License. Alt.TeL No.:
rWUit+sd by law. By my signaturethat the Licensee does not have the liabili ran No. --
ly
r Owner/Agent
rdbyl below,1 hereby waive this require I am the(check one insurance coverage no's ice
•
Telephone No. owner • owner's a:ent.
PERMIT FEE:$