HomeMy WebLinkAboutBLDE-21-006081 ;A.. 11 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-006081
t....:' 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:4/21/2021
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) 56 CLEAR BROOK RD
Owner or Tenant Ashley Saaden Telephone No.
Owner's Address 56 CLEARBROOK RD,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 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of solar PV system(21 Panels 6.825 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
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 0 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 Data Wiring:
Heaters Signs Ballasts 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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LLOYD R SMITH
Licensee: Lloyd R Smith Signature LIC.NO.: 15688
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:30 1ST ST, MELROSE MA 021764010 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
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: $150.00
"":"-
COMOSOIWIetik 01 Pl cluasib Official Use Only
rI
•
' l 2)e artnzent o f..ire Service4 Permit No. ! aseO O
P Occupancy and Fee Checked
-1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECT ICA WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME 5 7 t
(PLEASE PRINT IN INK OR E ALL IIIF RMATION Date: ...... ...1City or Town of: . L/(AVm OL To the Inspector o Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical wo described below.
Location(Street&Number) S C 1 e (-- %� >�)
Owner or Tenant n Sl , I *1• c51 I` ---������111 Telephone No ? N ' 1(O
Owner's Address Ci 73 a Jicti
Is this permit in conjunctio with a building permit? Yes ' No El (Check Appropriate Box)
Purpose of Building lc W i 1 Utility Authorization No.
Existing Service I`X j Amps ��/ �� Overhes Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: I� �.- 1 , Z 1 VcO1 ('n OUI\`L
,sCjt a v t\-E ,\ Ce, df 2S— ----L.. ...)
Completion of the following.table any be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf T
P Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
g grnd. 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. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
pore Totals: __....._ Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ M n icci ion ❑ other
No.of DryersHeating Appliances KW ,Security g stems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
dromass a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H y ag No.of Devices or Equivalent
OTHER:
/ _s,c-ylttach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of lec " Work: 1 , lOC) , (When required by municipal policy.)
Work to Start: 1 - Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO RA E: 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 suc coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
I certify,under a pains pe •• of peri ,that tth]information on t is app ' ' n is true and complete.
FIRM NAME:��I V i n t k��XnslJl i .NO.:
Licensee: P . ► �� Signatar _. O=
(If applicable,enter exempt"in the license number line.) __.__ Bus.TeL No.•
Address: C" W`tIteO S a1 i N Ivc4 n' 02- Alt.Tel.No.:
*Per M.G.L.c. 147,s. 7-61,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)0 owner 0 owner's agent.
Owner/Agent I PERMIT FEE:$
Signature Telephone No.