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HomeMy WebLinkAboutBLDE-23-003927 Commonwealth of Official Use Only 1,\1)6' Massachusetts Permit No. BLDE-23-003927 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:1/18/2023 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) 65 AVON RD Owner or Tenant JAMES KUBAT Telephone No. Owner's Address 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: Garage/Storage area. 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 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 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/Alertinu 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 Eauivalent 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 Eauivalent 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 perjury,that the information on this application is true and complete. FIRM NAME: Dominic Napolitano Licensee: Dominic Napolitano Signature LIC.NO.: 39347 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:828 GREAT FIELDS RD, BREWSTER MA 026312428 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 1 v (23 `9 era-- 6/.0 14 &ft) 4c Tp c z A Qe -6,.. WI ivy ( - -act-. A) 64.z., z43/z ite - lq, RECEIVED sash 0///laaeaehuestte Official Use Only I. w JAN 18 202S• s o� ti�+s Jsrvrese Permit No. Ez3-' 2 u L���F '�9R TL�P 'EVENTION REGULATIONS Occupancy and Fee Checked =� By [Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M ),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF MATION) Date: / /7 a 3 1 B City or Town of: 7 a f w1 0To the Inspe for o Wires: y this application the undersigned gives notice cells or her intention to perform the electrical work described below. w Location(Street&Number) (p 3--- Von R D 1 r Owner or Tenant l'Q wed * K 4T it en KO Inca-- Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building No to,t Utility Authorization No. Existing Service /(9 D Amps / Volts Overhead❑ Undgrd g 0 No.of Meters / New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity 7.1 Location and Nature of Proposed /� Electrical Work: GR' 'E/S to(1 q f c Ctpew /i Cis, t. (lc i..) '. 3- a 'Hefts 1-s& k i / ©D/ n Completion of the fallowingtab/e my be waived by the! for of Wires. Lb No.of Recessed Luminaires No.of Cell.-Sasp.(Paddle)Fans No.of l Z. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA st No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting No.of Receptacle Outlets 3Ernd. grad. ❑ Battery Units No.of Oil Burners FIRE ALARMS ,No.of Zones No.of Switches / No.of Gas Burners No.of Detection and l; Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW JNIo.of Self-Contained Totals:[... "" �� Detection/Alertin Deviees No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ * No.of Dryers Heating Appliances KW Security Systems:* No.of Water , No.of Data Wiring: No.of Devices or Equivalent Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromaasage 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: .57Q Work to Start: / (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 (gj BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties ofpeer3ury,that the information on this application is true and complete. FIRM NAME: b crm:v l c- ice, y- ez ti o E/eG�`(1'cto✓, L c G. /°�I' LIC.NO.: .353 Y'e--Licensee: Darn;,,r;c_ (On 01-4-,1•1 a Signature (If applicable,enter"exempt"in the!' ns numbe ine.) LIC.NO.: Address: 8.zc Gy ) re. rt f/} ©Q 3' Bus.TeL No.: �R' � f �7J *Per M.G.L.c. 147,s.57-61,security Alt.TeL No.: tY 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 ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ 1