HomeMy WebLinkAboutBLDE-23-18937 �j Print Form
EC E I D Commonweal of///a ach.a.�e Official Use Only
cc-�� Permit No. L23—' 09 3-7
la!= 2 c7e artmanh o f..JFire Serviced
" I' s 1 Occupancy and Fee Checked
HOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
BUht_DING OEFA IEN7 1
Lv —g— A-RPI-- CATION 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: 5/22/23
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)70 West Great Western Road
Owner or Tenant Starbuck Construction Services Telephone No. 508 827-7134
Owner's Address 176 Sudbury Lane Hyannis
Is this permit in conjunction with a building permit? Yes • No (Check Appropriate Box)
Purpose of Building House Utility Authorization No.
Existing Service 200 Amps 120 / 240 Volts Overhead n Undgrd n No.of Meters 1
New Service Amps / Volts Overhead Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 22 KW Generator with transfer switch
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf
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 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.on Initiating on Dete and
Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other
p Connection
No.of Dryers Heating Appliances KW Security
of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H
y g 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: Inspections 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 ❑✓ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: EAV Solutions, LLC LIC.NO.:860 Al
Licensee: Jeffrey Derouen Signature ��14,7 Z7¢,i,a4¢yy LIC.NO.:22206-A
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:(508)245-7155
Address: 110 Hedges Pond Road Cedarville, MA 02360 Alt.Tel.No.:(781)589-5692
*Per M.G.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 coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)E owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
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