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Home My WebLink AboutBLDE-23-002240 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-002240 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:10/26/2022 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) 23 STILL BROOK RD Owner or Tenant DMITRIY FILIPPOV Telephone No. Owner's Address 23 Still Brook Road, 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: Rewire house 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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 (c /3t 1 -ems. /(1 1' �D( I J h ACommonwaa Al �j .,.� al Official Use On!', .,, ; •�_' ;e', a / �G7sloart`nunt o`-} s' Permit No. L?j — �� ) I i l.,r srvreseLi Occupancy and Fee Checkedi '1. - ',..-9 _ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) _ r WORK APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W K u 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) City or Town of: YARMOUTH sy this application the undersigned gives ot�M his OUTHintention to perform the electrical w To the �kdes ribed below. s Location(Street&Number) >- _ • t IJ - Owner or Tenant °` \ _ t� Telephone No. t'F 1 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building__________ ❑ (Check Appropriate Box) Utility Authorization No. axiating Service Amps / Volts Overhead New Service ❑ Undgrd❑ No.of Meters Amps / Volts Overhead❑ Undgrd I❑ No.of Meters :j Number of Feeders and Ampacity --i_" Location and Nature of Proposed Electrical Work: 1-7�, cdrGt 1' ri Lik Com letion o the ollowin table m be waived b the Ins ector o No.of Recessed Luminaires Wires. �! No.of Cell.-Snap.(Paddle)Fans °�° ota No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA CA ' No.of Luminaires • Swimming Pool d. n- o.o rneits ,g n rod. ❑ rid. Bette Units g ' No.of Receptacle Outlets No.of Oil Burners "� FIRE ALARMS No.of Zones ' - No.of Switches No,of Gas Burners o.o etec on an 1.1 r No.of Ra nges Initiatin Devices No.of Air Conti. ota Tons No.of Alerting Devices No.of Waste Disposers eat ump um er ons Totals: o.o e onta ae No.of Dishwashers Detetection/Alertin Devices Space/Area Heating KW Local❑ nn p n ❑ Other No.of Dryers Heating Appliances KW. ecu ty Cystem o.o a er ° o No.of Devices or E uivalent Heaters ' °'° Data Wiring: Si ns Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecoromun a OA9 r gg OTHER: No.of Devices or E nivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: ( required by municipal policy.) INSURANCE COVERAGE: Unless waived by the owner,Inspections to be requested permit in accordance or the performance lof e electrical work may upon issue 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. unless CHECK ONE: INSURANCE 0 BOND ❑ OTHER ify:) I certify,under the pains and penalties o perjury,that the I formaton on this application is true and complete. FIRM NAME: rp ry' pp p LIC.NO.: Licensee: (If applicable,enter"exempt"in the license number line.) Signature LIC.NO.: Address: Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of public Safe 5"License: Alt.Tel.No.: �""- OWNER S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally No. required by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent owner Signature � owner's a:ent. Telephone No. f1 PERMIT FEE:$ 7 S.DO