HomeMy WebLinkAboutBLDE-21-002594 Commonwealth of Official Use Only
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` Massachusetts Permit No. BLDE-21-002594
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)
City or Town of: YARMOUTH Date:the Inspector/9/2020
By this application the undersigned gives notice of has or her Intention to perform the electrical work d sc ibed below. of Wires:
Location(Street&Number) 16 AURORA LN
Owner or Tenant KELLY DIANE COPPUS(EST OF) g
Owner's Address CIO JOHN KELLY, 16 AURORA LN,SOUTH YARMOUTH, MA 02664Telephone N�.
Is this permit in conjunction with a building permit? Yes ❑ No ❑ '�
Purpose of Building (Check
Amps
Utility Authorization No. o
Existing Service Volts Overhead 0
New Service AmpsUndgrd 0 No.of tern
Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wire dishwasher,&refer.Add smoke detectors, Change devices. /�J J
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
Transformers Total
No.of Luminaire Outlets KVA
No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ElNo.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
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 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 Data Wiring:
Signs Ballasts No.of Devics 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
I certify, f p d under the pains and penalties o perjury,, is that the information on this applicationtrue and complete.
FIRM NAME: Peter Peto
Licensee: Peter Peto
(If applicable,enter"exempt"in the license num be r line.) Signature LIC.NO.: 14763
Address: 132 Wintergreen Ln, Brewster MA 026312258 Bus.Tel.No.:
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 El owner's agent.
Signature
J� J r �, . .o. PERMIT FEE:$50.00
C.o ewrrwsirk eifigroachadelk
OITIciat Tim t •
,: Zit ,it No. -24
\,„V"
Occupancy and Fee Check
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/0 ----
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code( EC).527 CMR 12.00
(PLEASE PRINT IN INK OR TYP ALL��OR� M t� TION,1 Date: 1� /2,p
City or Town of: \ To the 1 or of Wires:
By this application the undersigned gives t 0'. of his or her intension perform the electrical work bed below.
Location(Street& ber) / C A (,1 )at.
Owner or Tenant e, e., C , lA,U T
Owner's Address ,�°1
permit in conjoined°a a permit? Yes �•
Purpose of Building S i� (it ❑ ty (Cheek ,,
Existing Service
Amps / � J Utility Add . � .
its, 1Q�7�
,�. Volts Overhead 0 L' rd❑ ~
New Service Amps - Volts Ove
rhead 0 Ustigrvd 0 No.of M "-
Number of Feeders and Ampacity
Location,and Nature of Electrical Work: e
c etc R.eC( l �- 1g p �VI�G S .
A(L4� v" i 40 be tUOtest9 I c am ear, tmr, , ,tr t,mr S fi 1 �—
No.of Recessed Luminaires ` rnan•he xvrtnrd��the brim tvt, .
No.of Ceii.Susp,(Paddle)Fans Tna Or asformere
No.ofLuminaire Outlets Nor of Hot TubsKVA
Generators KYA
No.of Lu.ml ashes Pool Above Q 1a- Iva snk et
No.�'Reeepirrek OutletsNo.of Oil Burners �' � Battery Units
FIRE ALARMS f No.of Zones
No.of Switches No.of Gas Burners "r(o.oTl�eieetfmt end
Na of Ranges InitlatianDevices
No.of Air Cond. Toms ,No.of Alert*Devices
Na of Wade Disposers Heat Pumpber i�Coa4Lied
Totem:(Num�.`� —{ �" Y Na.of 3
No.of Dishwashers SpacelArea Heating KWreViees
er
LoteelQ
0-. Ott ... .NaofDryers analog Appharas KWSecurity
No.of Witter Na of Ns.8f keti or Equivalent
Data Wiritar
HeatersKW No.of
Signs Ballasts No.of Devices or.Equivalent
Na Hydrot a Bathtubs No.of Motors Total HP _Pelecommuaic>t#lsss
OTHER: No.of Devices or h et
Estimated Value of Attack additional detail(fd�cd or as required by ire! '
Work tot Stag Work: (When requited by municipal policy.) ' °ttrte,ts
INSURANCE Inspections to be requested in accordance with MEC Rule 10,and upon completion.
GE: Unless waived by the owner,no permit for the performance of electric al work
the licensee provides proof of liability insurance including"completedmay issue The
undersigned certifies that such co is in force,and has exhibiteder its substantial equivalent. The
CHT C"K ONE: INSURANCE proof of same to the permit issuing office.
I BOND [� OTHER [',J (Specify)
I Ce4 NA Nader of W on this ppli abort is date and c+oa ie j/ 2
• qry� y�'�nC.
Signature LIC.NO.: !c'/ �J
Address e bu Lea Wd LIC.NO.:rl (Yjl,U TeL No.:
M.G.L,c. 1�17 s. 7-ni 1,secureSahsty Alt.TeL No.:
OWNER'S INSURANCE WAIVER: I am aware that
not does the liability License: Lie.Na.
byrequired law. BY mY signature below.I hereby waive thisde insurance coverage normally
tSignature requirement. Iaus the(check one)Q owner Q owner's agent.
Telephone No. I PERMIT FEE:$ 1