HomeMy WebLinkAboutBLDE-23-003586 -y.
Commonwealth of Official Use Only
'.' , r Massachusetts Permit No. BLDE-23-003586
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:12/31/2022
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 described below.
Location(Street&Number) 50 PARK AVE
Owner or Tenant LILIEBERG CARL J III Telephone No.
Owner's Address LILIEBERG LAURA J, 908 LINDSLEY DR,VIRGINIA BEACH, VA 23454
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No. (. 2 J` oe s.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters )ire C `
New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters (C) ',
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring for single family residence&install generator
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 90 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- ElNo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 60 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 33 No.of Gas Burners 2 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 2 Tons Tota 3 No.of Alerting Devices
No.of Waste Disposers Heat Pump Number , Tons KW No.of Self-Contained 9
Totals: Detection/Alertine Devices
No.of Dishwashers 1 Space/Area Heating KW Local ❑ Municipal ❑ Other:
Connection
No.of Dryers 1 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 Eauivalent
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. • 1 6% — S 657
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: Luis Miranda Signature LIC.NO.: 22981
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 7 Washington Avenue, Ashland MA 01721-1958 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
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$41 EC 2 0 2022 Commonwea[fh o f///addachadeile Official Use Only
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Permit No.
701111.r- F ,. u c Ire oruicsd
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Occupancy and Fee Checked
w' ` .v. 4ARD- 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(MEC),5277 CMR 12 0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /0/ II�t? _
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned a notic is or a intent' t perform the electrical work described below.
Location(Street&Number) v
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunctiop4,th a building perm a Yes 1 No ❑ (Check Appropriate Box)
Purpose of Building 1//�,5/2)�r`1 7 Utility Authorization No.
Existing Service Amps / Volts Overhead Undgrd❑ No.of Meters
Ne New Service ,, ,t AmpsVolts Overhead Undgrd❑ No.of Meters
' Number of Feeders and Ampacity _
Location and Nature off Proposed Elec�cal Work: ✓� - 1ii1/"-&/ 9�J� ���CG /�
, —Wt z4 geu l;-6- Z _
Completion of the following table m be waived by the Inspector of Wires.
skri
i)i No.of Recessed Luminaires c ` No,of Ceil:-Susp.(Paddle)Fans No.of- "Dotal
n'r ` Transformers KVA
rS No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Wit' No.of Luminaires Swimming Pool Above ❑ In- ❑ 'No.03 Emergency Lighting
grad. grad. `Battery Units
t No.of Receptacle Outlets be No.of 011 Burners FIRE ALARMS No.of Zones
No.of Switches 5 5 No.of Gas Burners -No,of Detection and
II! No.of Ranges No.of Air Cond. Total
Initiating Devices
zC Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers 1 Space/Area Heating KW Local❑ Municipal
/ Connection 0 Other
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or E No.of Water
Heaters Signs Ballasts
KW No.of No.of Data Wirin Equivalent
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 E ectric I Work: (When required by municipal policy.)
Work to Start: 2-Q - Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO ERAGE: 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 o same to e p rmit'ssuing office.
CHECK ONE: INSURANCE S. BOND 0 OTHER 0 (Specify:) (� AI c. �` i/&3
I certify,under a pales and rna1:ies of perjury,that me information of c Y 1 u 111/a comp c(�l
FIRM NAME f pp ieatton is true and complete
LIC.NO.::_ lq
Licensee: S ,r Signature LIC.NO.: !ZZS7 1?
(Ifgnplicabl:7nte "exem.t=' the ic &e um.er 11. erl
Address: # it AMA AL V /I Bus.Tel.No.
Alt.Tel.No.: '*Per M.G.L.c. 147,s.57-6 ,security work req ires' Dep of Public Safety Sense: 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 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$