HomeMy WebLinkAboutBLDE-22-002010 or Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-002010
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:10/8/2021
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) 1039A GREAT ISLAND RD
Owner or Tenant BURDEN NANCY L TR Telephone No.
Owner's Address C/O JENKINS JOSEPH R TR, 116 FLANDERS RD STE 1100,WESTBOROUGH, MMAA001581
Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec ropriate Box)
Purpose of Building Utility Authorization Ito4,
Existing Service Amps Volts Overhead 0 Undgrd k rs
New Service Amps Volts Overhead ❑ Undgrd N► o. e s
ii
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of generator441,
Completion of the following table , a ' .i • t nspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformer• 4 , KVA
No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 22
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency igi�i
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
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/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
Connection
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
No.Hydromassage 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: (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 ofperjury,that the information on this application is true and complete.
FIRM NAME: DYLAN,W ARSENAULT
Licensee: Dylan W Arsenault Signature LIC.NO.: 53495
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:2900 CRANBERRY HWY,LOT 25,EAST WAREHAM MA 025381321 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
&. ae&el Naugichaida off Use only
Occupancy andFee Chocked
BOARD OF FIRE PREVENTION REGULATIONS titev. (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
AU woto be performed in acconionce with the Massachusetts Electrical Code(MEC).527 C'MR 12.00
(Pr T.RA EPRINTININ%OR " 'E INFORMATION) Date: (0 Jn7iiiv/
City or Town of: r i3U To the inspector of Wires:
By this application the r < notice of his or her intention to perform the electrical work described below.
Mosher)London(Street& I O 2) I y ( e I Sloth
Owner or Tenant p,3 01 iv Telephone
Owner's Address
Is this permit is conjunction with kbuilding permit? Yes ❑ No 0 (Cheek APPro1 Box)
Purpose off ,l;n y (t' ). Opt(()) Utility Authorisation No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ Ne.of Meters
Amps 1 Volts Overhead 0 Uadvd❑ No.of M s
Number of Feeders and Ampacity
,.,,., and Nature of l W 1 2 2 k ix J
(ko Zoe �7, I ' � a nG it
Conteletion 'thef oilowh au be wised by the
No.°MR,eoeeeed L NIL (Paddle)Fa _�N eft KVA
No.of Lmninaie+e Outlets No.of Hot Tubs Generators KVA
Above o.otsinergamey Wittig
No.of Luminaires Swimming Pool ❑ Q B t
Arad. Arad. Battery units
No.of R Outlets No.of Oil Burons FIRE ALARMS INo.of Zones
and
No.ofSwilU No.of Gas Burners �DIvioa
No.of No.o€Air Cond. Tom` 'No.of Alerting Devices
No.of Waste Disposers Heat NumberTen8�i► �Seli-Centabeer
No.of Dishwashers SpeedArea Heatbg KW Local 0 0 Other
No.efDryers Heating Appliances KW
efceviea or Univalent
No.of Water KW No.of No.of Data Wiring:
Beaten Sivs Masts No.of Devices or
Na Hydros Bathtubs No.of Meters Total S! TekemannadadionsM
No.of Devih:es or
OTHER:
Attach additional detail rdethrid or as revoked by the Inspector ofFfirer~
Estimated Value ofElectrical Work (VWheu required by policy.)
Work to Start Inspections to be requested in acconlancewith MEC Rule 10,and upon completion.'
INSURANCE COVERAGE: Unless waived by the owner,no permit for the perfomunce of electrical work may issue unless
the license provides proof of liability ime once "a3mpleted operation"coverage or its dal equivalent The
undersigned certifies that such coverage is in force,and has exit:liked proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND ❑ arm 0 (Specify:)
I ehhu jv,snap thepairs end s eperjwy,that die"tionsnime es*Is epppiasdon is tsse old complete.
PI M '... PG~tfl iG d If LIC.NO.:
Licmmee: LIG NO.: F" AWs
(ropplicabk, thL ) Baia.Tel. ' ;iiri.i'
Address: I� 7�ats) 'brgeh 4 cife o M14,O 67P Alt.Tel.Nle.;
M.C.L.c.147,s.57-61,security work 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 covaage Imeryboly
required
by law. By my below,I hereby waive this requirement 1 am the(check one)Downer [l owner's age.
re
Atha •
Signature Tease No. 1 PERMIT PEE:$