HomeMy WebLinkAboutBLDE-23-005157 ,or.__ 4cfe-
Commonwealth of Official Use Only
\V Massachusetts 1PermitNo. BLDE-23-005157
�'"° 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 PR INTIN INK OR TYPE ALL INFORMATION)
City or Town of: YARMOUTH Date: Inspec023
To thT
By this application the undersigned gives notice of his or her intention to perfornr the electrical work described below r of Wires:
Location(Street&Number) 38 BRUSH HILL RD
Owner or Tenant PHILIPPE GENEROSO
Owner's Address 38 BRUSH HILL RD, YARMOUTH PORT, MA 02675 Telephone No.
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
New Service Amps Undgrd 0 No.of Meters
Number of Feeders and Ampacity Volts Overhead 0 Undgrd ❑ No.of Meters
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Location and Nature of Proposed Electrical Work: Replace fire dams ed wirin &devices.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 16 No.of Ceil.-Susp.(Paddle)Fans No.of
No.of Luminaire OutletsTransformers Total
No.of Hot Tubs KVA
Generators KVA
No.of Luminaires SwimmingPool Above In-
rnd. ❑ •rnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets 33 Batter Units
No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 16 No.of Gas Burners
No.of Detection and
No.of Ranges Initiatin Devices
No.of Air Cond. Total
No.of Waste Disposers HeatNumberTo sons
Pump No.of Alerting Devices
Totals: KW No.of Self-Contained
No.of Dishwashers Detection/Alertin. Devices
Space/Area Heating KW
Local 0 Municipal 0 Other:
No.of Dryers Heating Appliances Connection
No.of Water KW Security Systems:*
KW No.of No.of Devices or E.uivalent
Heaters Si' No.of Ballasts Data Wiring:
No.Hydromassage Bathtubs No.of Devices or E i uivalent
No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or E,uivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: (When required by municipal policy.)
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 )
1 certify, f perjury,
,under the pains and penalties o er ur that the information on on this a l i�tiony Pis true and complete.
FIRM NAME: y' PP
Licensee:
Signature
(If applicable,enter"exempt"in the license number line.) LIC.NO.:
Address: Bus.Tel.No.:
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.
Signature
Telephone No.
(/ (P'E
, ,/ PERMIT FEE:$75.00
-
--. RECEIVED
�� _ ��AR 2 _c? ►►rr o I wealth of Massachusetts ftiicial Use Onl
Permit No. 3 I S
7� Department of Fire Services Occupancy and Fee Checked.
= BOARE'7ROF FIF�,E PREVENTION REGULATIONS [Rev. I/2023]
yr`'� t
l'' _ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: � YARMOUTH Por,+-
Date: 0.5/Zc:) / off-I
To the Inspector of Wires:By this B application,the undersigned gives notices of his or her intention to perform the electrical work described below.
� O
Location(Street&Number): w St, 14,I i -)
Owner or Tenant: R;r� t, , Unit No.:
Owner's Address:Tenant:
�� 6ey1 ,-c05o Email: �It ePe.. 1e 0-S0 �a1l •(.O�
�`b ru jh 14 11 (c� ►
Phone NO.: ,so�j 3(vv g USA
Is this permit in conjunction with a building pe ut?(Check appropriate box)Yes[A No❑Permit No.: ,{3LO-23--c O 4 I 3 9
Purpose of Building: c;k ;
�� �;� (�t��.,t^5-�. Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground
New Service: Amps
0 No.of Meters:
/ Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Q.pl., Get,e,�w�Z.i�
��/ �-_RM1�Z s r, ` , - k,.� �.. , ��) k ^v l. 1 >ae s �v) r anti,
V s'c'J'J`'\ ,C.UdI %-\O;)y' 04uk iC*-6Ae n 'c
Completion of the following table may be waived bythe Inspector1. �l t e
No.of Receptable Outlets: of Wires.
3 No.of Switches: re"-- Generator KW Rating: T e:
No.Luminaires: No.of Recessed Luminaires: j Yp
No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No. Water Heaters: KW: No.Transformers:
Space HeatingKW: Total KVA:
Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.0 Hot-Tub
No.Oil Burners: ElNo.of Self-Contained Detection/Alerting Devices:
No.Gas Burners: Video System y 0 No.of Devices:
No.Air Conditioners:
Total Tons: Telecom stem S
No.Energy Storage Systems: KWH Storage Rating: y 0 No.of Outlets:
g Security System 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Ratin
No.of Modules: Roof-Mount 0 Ground-Mount g• No.of Electric Vehicle Supply Equipment:
OTHER: 0 Level 1 0 Level 2 0 Level 3 0 Rating:
................
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
Date Work to Start: (When required by municipal policy)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
Master/Systems Licensee: A-1 0 or C-1 ❑LIC.No.:
Journeyman Licensee: LIC.No.:
LIC. No.:
Security System Business requires a Division of Occupational Licensure"S"LIC.
Address: S-LIC.No.:
Email:
Telephone No.:I cert j,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee:
Print
INSURANCE COVERAGE: Unless waived by he owner,no permit for the performance of electrical work may
Cell. No.:
provides proof of liability 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 of❑ office.
Issue unless the licensee
CHECK ONE: INSURANCE❑ BOND
OWNER'S INSURANCE WAIVER: I am aware that the❑Licensee does not have
elow,I hereby waive this requirement.I am the:(Check one)Owner Ow
the liability insurance coverage normally
required by law.By my signature b
Owner/Agent: — 11 ❑
Signatur . J
Tel.No.: (>}� ner's agent 0
' ( vc-7
Email.: I,�e truer,
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