HomeMy WebLinkAboutBLDE-22-006202 or tft,‘
id�lli✓° Commonwealth of Official Use Only
L. \ Massachusetts Permit No. BLDE-22-006202
,
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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:4/27/2022
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) 15 ARCHIE RD
Owner or Tenant NOCRASZ STEPHEN E
Owner's Address 15 ARCHIE RD,WEST YARMOUTH, MA 02673 Telephone No.
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check
Purpose of Building Appropriate Box)
Utility Authorization No. 8717355
Existing Service Amps Volts Overhead El Undgrd 0
gNo.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. (15 Panels 6.0 KW)(NO SUPPORT
DOCUMENTATION)
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 I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total
Ton No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal
Connection 0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Ballasts Data Wiring:
Siens No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER:
No.of Devices or Equivalent
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: COLBY PERRAULT
Licensee: COLBY PERRAULT Signature
LIC.l NO.: 22560
(If applicable,enter"exempt"in the license number line.)
Address:53 OLD EAST BROOKFIELD RD, NORTH BROOKFIELD MA 01535 A . Tel o.::
Alt.
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: 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 0 owner's agent.
Owner/Agent
Signature Telephone No. I
n j t I PERMIT FEE:$150.00
IC
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C..onononarva ! m l> f ri .:.ri t ,-c r rah.
�tpa,iw,ret el Jir e Jsrvict7 Permit No r
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(kcupancs and Ice('her.ked
BOARD OF FIRE PREVENTION REGULATIONS Mites. F 971 ftesrte ht,,,,kr
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
III work to be pertormed to atcorJanee with the ttassachueettc f Fectricat C'orie MI('}. S27 t'%t 12 fin
IPLEASE PRINT LV LVK OR TIaALL!V'F()R.tfAT1(1,V) Date: /.Qc5 aa,
City or Town of: 'jar- m 0 GL.,. •l To the Inspector of Wires:
Fay this application the undersigned gises stir'ofhis or ..r intention to perform the electrical work described below.
Location(Street&Nu her) 15 chi e. oa d
Owner or Tenant S�2p-h r� N oc rc& Z Telephone No.
Owner's Address S aPi1e.. a hpv e
Is this permit in conjs�tion w'h a ilding emit'' Yes No
Purpose of Building �/1 Qt��, p� 0 (Check Appropriate
51 Utility Authorization No. 137/ 7,355
Existing Service/O ) Amps kV Ica Votes therhead �:' Ind rd>~ -0 No.of Meters i
Ness Service Amps / Volts (herhead❑ Usdgrd Q No.of Meters
Number of Feeders and Ampacity
Location and Nature of Electrical Work: 10.�
Consi'S-�.vl 0 15 So ans oo w
( ,)„,pie,,,,,„of the folloscta Lah/,-met be r+ucteJ hi the Irc,nector or It;re
No.of Recessed Luminaires No.of era-Stop. o.of Total
mil►-(Paddle)Fans ,Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs (venerators KVA
Above In- No.of Emergency No.of Luminaires Swimming Pool grad. Lighting(trod grid. Q Batten !bits
3• No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones R
No.of Switches No.of Gas Burners 'No.of Detection and
Initiating Desires
tat
No.of Ranges No.of Air Coma. Total
Tons No.of Alerting Des ices
No.of Waste Disposers Heat Pump Number Tons KW _ No.of Self-Contained t
Totals
Detection/Alertin“Des ices
No.of Dishwashers Space/Area Heating KW Local Municipal
Connection Other
io.of Dryers Heating Appliances KW Security Ststcros:*
`o.o!Water to of Des ices or Egnis alert
I.
F
. Heaters KW tio.of No.of Data Wiring:
Stgtts Ballasts of its ices or Efpu►salmi
No.An Hydromassage Bathtubs No.of Motors Total HP ,Telecommunwaturns N trim:
----...c) i No.of Desks-.or Equisalent ;
OTHER:
�tttaE"{r arts�l rqu.<� ,',(. ;: .,r r r ;t i Da ic.'r �I r',• !it swtr
I stinisEed Value ot'lJeer peal Work: �o3Su !When required hs tnfuticrpfl prrltes t
Work to Start: Insp tenons to he requested in act rdance with Mi C kirk' Iir,,md upon ;'mpktion.
7
INSURANCE C VE (.F I'nles.wailed by the owner,no permit for IN.
'prrhort t,i[Ite't*t i Ie'itrteal work in;t:k issue unless t
the lfrert4ee prosides pn>rrt of It►E►tlit} insurance including"cfxnpktcd operation"crrsrr.rrr t+r Its.tth.t,tn[iat cittrn.ttrrft. the ftndcni ne l eertiFie,that roue!(cosertne is in torte, trot has exhibited prfxrt'otwtttre err the prrrtttt i..uin ,rtli.,e
t ill_CK ONl;. iNSI'RANCI. 1g FIONI) Q t)1HER 0 !Specify)
I certify,under the pairs and penalties of pedury,that the information on this application is true and complete.
"zJ_ FIRM NAME: Q, ,.1� � -1.. �rrr : CE_[.
„"C Licensee: 4 h / �e , i"�. 1 Signature .S 0
dr aph,!,,„i,l, ,nh r r t,mpt to r l:c z re r„:other line j .'."7 L1C �O..
Address: 3 ( i,s �_. colt lrL�z "t t. ;. � 1 � :f(� ',,;Bus. fel No.•t <' ' % � - >1 i
`i'cr tF(,.I c I47,s_57-t,l.security work require'.lkp.utrnent of Public Safety"S.-I het. fee. St►.-
.='3 OWNER'S INSURANCE WAIVER: I am aware that the I icons e doe+not hare the liah his insurance coN.era t ncrnnatt)
required by law. By my signature below.I hereby wady this requirctnent. tan the(check true) owner owner's;gent
r ()Ironer/Agent
Signature Tekphone No. PERMIT FEE: S