HomeMy WebLinkAboutBLDE-22-7100 UNIT A Commonwealth of Official Use Only
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Massachusetts Permit No. BLDE-22-007100
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:6/8/2022
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) 12A&12B ROSEMARY LN
Owner or Tenant JOHNSON NANCY L TR Telephone No.
Owner's Address N L JOHNSON INVESTMENT TRUST, PO BOX 342, HYANNIS, MA 02601
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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Change panel& rewire living room, bedroom, kitchen, bath, Ete
t_ ,
Completion of the following table may he 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
1nitiatine 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.
CHECK ONE: INSURANCE 0 BOND ❑ 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: $75.00
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RECEIVED
,� /I irashorite official Use Only
o ' 2022 PernikWo. -- `z�-, ' C 00
0A; Occvancy and Fee Checked
,. /%. CIF -E PREVENTION REGULATIONS (Rev. 1/07j tleavewank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
MI work to be performed in accordance with the Massachusetus Electrical Code( ). 7 CMR MOO
(PLEASE PRINT IN INK OR I E ALL INF.O$IATION) Date: ,6 7 2. .
City or Town of 4 7" To the 1 or Wires:
By the application the :.4 . ves notice ofhie or lux intern to pe rfa m the el ectrimI want described below.
Loco a(Street&N ) t#— DS(Z wiCL
Owner sr Tease V ' (-Ur\4 ?-'1\t Cam. _ elephone No.
Owner's Address
Is ilia permit is annuagion wk a ma, permit? Yes 0 No ja (Cheek Appropriate Box)
Purpose of Bet l�es i :�y`+", 1 tttiftty Ante No.
Existing Service____ Amps I Volts Overhead 0 Uncivil 0 No.of Meters
New Service Amps / Volta Overhead 0 CTadird 0 No.of Meters
Number of Feeders and Ampreity ,
London and Platare of Proposed Eleehlaer Week: et 1 V W \ v, -vJ3/40atte)
tit)1 are 1--1utu C� . ,
�`�' 04 u S 1 5 Cdrletka�tite.M rebde srr+,v be raked by the fnepeelar gf Wino.
at Taal
Ne.of Rid Le es No.of Colt Sap.(P e)Fans Ta
Trauptanesers KVA
No.of Laiaahre Outlets No.of Hot Tots Generators KVA
No.of Luminaires Swimming Peet Aka,*
e ❑ ant 1 a ybeltway
mai
No.of Receptacle Outlets No.of OH Burners FIRE ALARMS tNe.of Zones
of fietectioa and
Na of Sit/Relies No.ofGas Bunters *No`
Whiting Devices
No.of Ranges No.of Air Cond. Total No.ofAlerting Devices
'In.ofWaste Disposers Hest P Number{T4 _. 1M_.... Na l Galtaieed
Totals: teetiortglevices
Ne.of Dishwashers S ce/Areea Heating KW Leddo p mull"' 0 Whir
II
Na.of Dryers Heating AppRanees KW
'eta situate` KW 'No.of No.of Data y �t
HastenSias Ballasts of + or ' ,tx t
Na H*sasaasage Bathtubs No.of Motors Total HP ""
Ne,ref + hexer or � , ;, t
OTHER:
Attack detail(''desired,or as repotted by the bupecror of Wires
Estimated Value of Electrical Work: (When 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`wed operation"coverage or its substantad equivalent. The
undersigned certifies that such •, R .., is in force;,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE WI BOND 0 OTHER 0 (Specify:)
l wet,wake * veuuMii n this spprlkido.is true and
����� ' .. , ��'. �� LIC.NO.: I���63
Linage: `� �`-reA70 Signature t LIC.NO.:
afqtpitcuMe, to lice�r+arerbrr ) Bea.Tel.No.:
Address: t%- LC.�i L� �' � �',4' v Alt.Tel.No.:
*Par M.G.L.c. 147,s.S7-61.security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hare the liability insurance coverage normally
requited by law. By my sign below.I hereby waive this requirement.ment. I am the(check one)0 owner 0 owner's agent.
Signature Telephone Na 1 PERMIT FEE:x'