HomeMy WebLinkAboutBLDE-23-004865 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-004865
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:3/4/2023
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) 219 PLEASANT ST
Owner or Tenant JAMES MODISETTE 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: Re-bar grounding(UFER)
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 TotalTransformers 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
Initiatine 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
Totals: Detection/Alertinn Devices
No.of Dishwashers Space/Area Heating KW Local ❑ M n union
ion cal 0 Other:
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
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total HP 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.)
y'
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:
Licensee: JULIAN ROBINSON Signature LIC.NO.: 58376
(If applicable,enter"exempt"in the license number line.)
Bus.Tel.No.:
Address: 126 Santuit Road, Marstons Mills MA 02648 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. I PERMIT FEE: $50.00
eta ' ,j1O /v , 1�
1P. ECEPVED
Official Use Onl
o •nwealth of Massachusetts Permit No.: 2J-�V(
- 3 20 Occupancy and Fee Checked:
1_ a artment of Fire Services p y
I+ a A►J DA `IRE PREVENTION REGULATIONS [Rev. 1/2023]
-_' ___ , - - A ION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed-in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH Date: s/3l 2 0 z 3
To the Inspector of Wires:By tiAs application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): Li i P I e&,.Sc.i.0--S t Unit No.:
Owner or Tenant: ( het C S t 1415 C-]'{-R Email:
Owner's Address: 'Z1 ct (?(ec.S c.41- S f- 1.0-'h 641, f-tj' Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes I'] No 0 Permit No.:
Purpose of Building: t o t,u t-'(.1-I`1", (3 0"4- Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground 0 No.of Meters:
Description of Proposed Electrical Installation: F 0 v 0 d'•-°1(`,11 13 ok L
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:.
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
_No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical/ Work: ( °0 (When required by municipal policy)
Date Work to Start: -j! 3/2 d 2 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 3( I d i`, &Ire v ' A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 3-U 1 1(--vt R.o b i t^S otn LIC.No.: 5 9-3 76" 0
Security System Business requires a Division of Occupational Licensure S LIC. S-LIC.No.:
Address: 1-2,6 5 +v 1 t- e,wt-o i~t Z O v't a(,.. 4-°k t NL t`l 13 rim_ 0 16 c(
Email: JU << Ekt\ PoIi1,(0.4. (4c Q. Gw,4, t,L4t.', • TelephoneNo.: 72( -3 (k-0i-Z(4.
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee:
Print Name: Cell.No.:
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability 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:
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)Owner 0 Owner's agent 0
Owner/Agent:
Email.:
Signature: