HomeMy WebLinkAboutBLDE-23-004957 Commonwealth of Official Use Only
�j� Massachusetts Permit No. BLDE-23-004957
a...p BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/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:3/9/2023
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) 11 SPARROW WAY
Owner or Tenant RITA ANDRADE Telephone No.
Owner's Address 11 SPARROW WAY, 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 0 In- ElNo.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
Heat Pump Number Tons _ KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 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 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
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'ir - -- --elm,..___ ..._.._. dill Permit No. �r.3-`"� l`7��
4
� � � � MAR o 9 2023 �BP
Occupancy and Foe checked _— ,,_
s REGULATIONS (Rev. iron own
,_ BY._____
ICAL WORK
APPLICATION FORPERMITAu wet to be porhookod TO PERFORMcol CE� CC,5"7 CMR
INK INFORMATION) Date: 31 1 �,2 3
(PLEASE y er C4 riAA< 1 Li To the inspector t f Wires:
By� y io Tows i os igned • nodes obis orbs to platoon the deckied work described below.
Leaden Nerd S 0 CA Y \.k.) ackr
Owner arTome Ri-LCPN to c Telephone No.
Oweeea Address
with o permit? Yes 0 No 4 (Cheek Ap a Bo)
is permit in [cry Ali Ne..
Hof Qgi t `Ci
triskag Smoke Mims I Veils Overhead 0 Vatterd❑ No.of Meters
Veils Overload 0 U .lie rd 0 No stMeters
Navaho.offeeders saddand NMI" � i��Z1c I�l S c �cJ,
of Proposed Bedded Work: ec r Sce C 1 , i k c'rk
S t CA,f 0X1 A k t C 1nC'�i VI-1-cv� S I
�t,V l� V� Cesooktatet ofrke lb +► be wei vdhi� of nit.
Ragweed lain No.of Cefs.•Swp►(P�)Fame r_ KVA
Na.of KVA
No.of Ltirtilaaire Ondess No OHM Tabs
�or s�ntsReaeF uponNw of l.�iaaires Peat tip 0
.. MRE ALARMS IN..of Zones
unnip
No.sty E No dal Barron
off No KGas Reraere Pia of peteetent
llahhnl)[Devi es
No.of Coed od
Ter No.of Alertly. r
3yw siF�es ;No,s[Sa�eMrirw�
No.ewe*DltpesersTPi �
No.atDfanmehen -Space/Ann KW Lees)0 0 Othw
No of Dcysn Anemia K11► lass E - sr Katalvdent
No. Bea acNr i�v films Sallasts l Widow m Air- rr : ;
No No.of Motors Total HP ..'
OTRXIb
Mack adtilletod detail OrdestreeL or m requited by the boomer(Wino
Estimated Value of Electrical Work 3,5 0 (Wien
rewired by muScipal policy.)
Work to Siert 0 J to be in aeoordaace with MEC Rtde I completion.
ofdeetrical work nay issue ue as
CHANCE Clv� thdam waived by the owner,no permit far lbs peration"coverage or
the licensee provides liability including ° ,mne to the perm issuing .
its sguartial co:dinged. The
undersigned certifies t such ., is in tamer,and has edified proof
CHECK ONE: mywi t -�aid piptilks ep rD Cl ,that the h0 «sacra Iltl ad�oe i.
lnab NAME;
C--Ee y t c-� v&.C.t c,w\ `� IX.NO 1 t 16 3
-f ( t Jj LIC.NO.:______
theme: �� 8�ae.Ter).Not.,
f Ro�r .. $ ew c Alt:Td.No.:
*Pe racer 1 ere of Public Salty"s"License: Lie.No. _
*Per M.OWNER'S
c. UI s,3'>:61.securityWAIVER:
work
owN 'S I( TCE WAIVER: tam aware d the LieaAaee days 1we am vi
the liabdky
one)insurance
t-t pointer 0 maces coverage
noin afeeat-
require' el*by taw. By my a below.I ls� this1•+
oirardAgeat 1
TeyppaeNo. PERMIT FEE:s 1