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Home My WebLink AboutBLDE-22-004000 co Commonwealth of Official Use Only U. - Massachusetts Permit No. BLDE-22-004000 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:1/19/2022 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 Blow. Location(Street&Number) 15 GARDINER LN J"1 Owner or Tenant i � Telephone No. Owner's Address M61 'D 11 Is this permit in conjunction with a building permit? Yes ❑ No 0 Purpose of Building ^� Utility Authorization Existing Service Amps P Volts Overhead 0 Undgrd New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service, kitchen/living room lights,fur c-, : detectors,. Completion of the fo . i' r 4. ij e Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.o I' Total Transfor 1 • piok No.of Luminaire Outlets No.of Hot Tubs Generators � t A No.of Luminaires Swimming Pool grnd e ❑ g nd. ❑ No.of Emer iWq)ix Battery Unit No.of Receptacle Outlets 10 No.of Oil Burners FIRE ALA S /''1. . one VIP No.of Switches 9 No.of Gas Burners No.of Detection an i Initiative Devices No.of Ranges 1 No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices 5 No.of Dishwashers 1 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 KW No.of No.of Ballasts Data Wiring: Heaters 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 o perjury,that the information on this application is true and complete. .fp lur y, FIRM NAME: Robert J Carreiro Licensee: Robert J Carreiro Signature LIC.NO.: 19861 (If applicable,enter"exempt"in the license number line.) Address:2 RITA AVE, S YARMOUTH MA 026641976 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.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 ❑ owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$75.00 K1I 14 24 1 Vigt-Pef RECEIVE ® JAN , 92022,2 ° ith of/// hula --`14'� �jril�Ul{dG UEi ARTM T Offi)cialUse 0 ty -_stl -A — arbna rf°� s Permit No, '22— •_I_ crvices :• ;r `` BOARD OF FIRE PREVENTION REGULATIONS--- Occupancy and Fee Checked I 'ev. 1/07] ea„blank All work to be performed in accordance with the Massachusetts Electrical c ikivi Lt� ' ,A'�L WORK ORK (PLEASE PRINT IN INK OR TYPE ALL INFO (I+g�),527 OAR 12.00 City or Town of: �r� D�� RMATION i 9 ,� By this application the r,n of: eagives V OUTH ) To he Inspe for o tress i notice of his or her intention to perform the electrical work described below. • Location (Street&Number) Owner or Tenant / p _ . no Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building �FS, .G � No ❑ (Check Appropriate Box) Utility Authorization No. ' TG 3 9� Existing Service/4 c) Amps /Z�¢p Volts Overhead New ServiceES.,. Uadgrd 0 No.of Meters / /OW Amps r24, Volts Number of Feed Overhead Undgrd No.of Meters i ers and Ampacity Location and Nature of Proposed Electrical Work: Viive i `A �C JE�'Vlce rc);�� j i�cNr�7lJ Completion o the ollowin- table m. be waived the Ins.ector of Wu-es. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans o•of Total No. of Luna N inaire Outlets Transformers KVA No.of Hot Tubs Generators KVA o.o No.of Luminaires Swimtuiag Pool Aboved. in- ' g tangNo. of Receptacle Outlets grn El 'md' El Bane � Units _ , C> No.of Oil Burners - No.of Switches No.of Zones C� No.of Gas Burners `o.of Detection and No.of Ranges Initiating Devices No. of Air Cond No.of Alerting Devices No.of Waste Disposers Heat PumTons Totals: amber TonsNM o.of elf-Containe, No.of Dishwashers / Space/Area Heating KW Detectio Mum no Devices S�' Local Municipal No.of Dryers HeatingAppliances ❑Connection_ ❑ Other No.of ater pp KW Security Systems:* - Heaters KW No. o o. of No.of Devices or E.uivalent Si• s Ballasts Data Wiring: No.Hydramassage Bathtubs No.of Devices or El uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or El uivalent Estimated Value of Electrical W Attach addition,,!detail if desire Work d orc ys required by the Inspector of Wires. Work to Start: (when required by municipal policy.) INSURAN Inspections to be requested in accordance with MEC Rule 10,and upon completion. CE COVERAGE: Unless waived by the owner,no permit for the performance the licensee provides proof of liability insurance including operation" undersinsedp o ifies p o such coverage is in force, and has Complete proof of P ve ge of is subi to wore uim is g ex ibited proofofa to thehee or its issuing of office. equivalent. unless CHECK ONE: INSURANCE ! same to I certify, under BOND 0 OARPermit issuing office. � aims and penalties ❑ (Specify:) FIRM NAME: to `! J . • C�4perlury, that the information on this application is true and complete Licensee: c2 o 'C ,2tC -AK—) (If applicable, rater " RR�%/'t� Signature LIC.NO.: L2 � exempt"in the license number line.) —_ , Address. .C). /36N- a e LIC.NO.: J "Per M.G.L. c. 147, `m s.57-6 I,security Bus.Tel.No.; ..� v OWNER'S INSURANCE WAIVER: work requires Departm rat of Public Safe 4!�Tel. o. �'S�' required by law. I am aware that the Licensee does not hav the liability t y 3� Owner/Agent By my signature below I herebyLic. No: I Signature waive this requirement I am the(check one insurance coverage normal! 11 �❑owner [�owner's a r,. Telephone No. 1 AA'nalT