HomeMy WebLinkAboutBLDE-23-004054 OP Y
Commonwealth of Official Use Only
ht)..41' Massachusetts Permit No. BLDE-23-004054
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:1/23/2023
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) 54 PARKWOOD RD
Owner or Tenant NARDINE HALLAL Telephone No.
Owner's Address 54 PARKWOOD RD, SOUTH YARMOUTH, MA 02664
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: Miscellaneous work per attached.
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 Total
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.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 ❑ 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 of perjury,that the information on this application is true and complete.
FIRM NAME: Peter Peto
Licensee: Peter Peto Signature LIC.NO.: 14763
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 132 Wintergreen Ln, Brewster MA 026312258 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
e&AW *1243(Z5
zfr(o �
2023 , '! Permit No. ? ' '' �D,�
. rFr iJAN23 of I A*SVAtett
Occupancy and Pee Checked
\. /u ' -, , REGULATIONS [Rev. ( k)
■' A tQ FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfumed is accordant*with the hthosaciseetio Bestricad Code(I ),527 MR 12.00
(PLEASE PRINT IN INK OR TYP ALL INFO T1ON) e: itnL 3t£3
City !`i
er Ton et rui ' Dat To the 1-<, i of Wires:
Sy err Isar ,, _.., , ,to . .. ; ,:, the auk described below.
taesdi=(Shut*Na her) .-4 1 •' woo ` •
Owner orTea at 'J �;�i,V _ -N � 1 �,I Te phone N.
°wares Address
Is this perm*is isahmeetion gi,s handiag permit? Yes 0 No i (Cheek Appropriate Bet)
Parse of Ealleng RQ-S t 6kkAA ,,`A. 1 t'ttiy A Pia
Uses Sark, Any' I Volts Overhaul 0 L'i rd 0 Na.of Meters
Baltals ,_� Amps I Vacs Overhead❑ Und rd 0 No.of Meteor
Number of Feeders sad Aarpoeity
PTand Rita=of , . Work: C � SWtA -6 C et.t.4 it; ' S t kt INCk-t.S CIA. C-
Ye ` ' S'� c to -o..y i s 0t.c c s ea.k,�.e.. M zg c G LC.
caamhoett
*mei bob*kdaar „r! 'Sta.uck
No.of iifseoered Laawiaains Na of CeL4lesp.(Paddle)Pas ynumetrogn KVA
No.f Leath ai re Outing No Olio Tabs KVA Fs �
Svc la= mo. �.^�.� •r'
No.of Lermlrhsi �Past Q trod. CI x
Na.f Regeptide Oink* Na sf Olt Boaters FIRE AlAithestito.of Zones Tv of Switches No..fGas___ Pia iDefeeiben
)) 5
No.stRares No.etAir Coat T INo.of Bevkes Ci
44
Skit Pump f LT# !1 .�lo.of -t was
Na.if Dl�eea At ae [KW t Ladd : F 0 Ober
.1v�C}l 0
Dryers
Re.of Dryers ,of+ or Soolvekot
No.arwiater KWlt No of to.ewrrDataBatas .DaMans ta pre .A fir : .4 f -
Na Nydromessage Illadrobs Na of Milton Total HP +�+
ti'L11ER:
Atexherktistenaldetail(/de ineti twos wed by the Impeder qf
Estiaeoid Value of Electrical Work: (When rested by municipal policy.)
Wait to Sint lnapocticees to be requested in accordance with MEC Rule l0,add upon cotnpiadon.
INfillikANCE COVERAGE: Unless waived by the owlet,no permit for the paranoia=ordearical work may issue unless
the licensee vidss proof of pm vides proof ofikbility insaaaroe including aperrdiod"coverage or its sahmential equivelae. The
undersigned certifies that such coverage is is Race,and hes wed proof of same to the permit issuing affice.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:)
t c+ whir ash des ,,kr'r i�weeeti w ex Mt a k bmc ami ,,,, ,
FFERMI NAkillb �r E iec;-�- ' 'c�., I..NO.: i -
Mum I LkW 13C MESIMIft t i ' Lie NO.:
&breast asseskr kW 1-,? Ilea Tel.Pia:
�'weer�~la
\-v--f v �o S Alt Tel.Na.;
'Aar M.G.L.c. 147,a.57.61.axharftyl'v.uk requires>S arrisr a of Attic Safety"'S"License: Lic.No.
OWNER'S IMIURANCE WAIVER: I ma aware that the Licensee does am cars the liability insurance coverage normally
=pied by law. By toy sigamunt below.I hereby valve this regirement. I am the(check ode)(�j ootair ®onaa's went.
OwnagfAspat
Sigissont Ttispiseat No IFMUNTERE4