BLDE-23-004571 „. ,., /,A Commonwealth of Official Use Only
ki Massachusetts Permit No. BLDE-23-004571
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:2/17/2023
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) 25 HAZELMOOR RD
Owner or Tenant NICK RENZULLI Telephone No.
Owner's Address 25 HAZLEMOOR RD, SOUTH YARMOUTH, MA 02664-2926
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 ❑ 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: Kitchen remodel
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 5 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- ElNo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 10 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 5 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
Space/Area HeatingLocal 0 Municipal No.of Dishwashers P KWConnection
❑ Other:
HeatingAppliances KW Security Systems:*
No.of Dryers PP No.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
required bymunicipal policy.)
Estimated Value of Electrical Work: (Whenq p P y'
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. i7 `.q_7 5g-Q7 i r
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) i
application
certify,under the pains and penalties of perjury,that the information on this is true and complete.
FIRM NAME: Michael S Keller LTC.NO.: 20429
Licensee: Michael S Keller Signature
Bus.Tel.No.:
(If applicable,enter"exempt"in the license number line.) Alt Tell N o.
Address:8 Cedar St, Dedham MA 020263222
*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
0 owner's agent.
signature below,I hereby waive this requirement.I am the(check one) 0 ownerI
Owner/Agent 'PERMIT FEE: $75.00
Signature Telephone No.
ti /i9/i3Z
i'VA. _.66.7,12.3 I (i(:6s,a,44 Ll&)
RECEIVED
16 2023
i fficial Use Onl
lrQ1111nIOntNealtll of Massachusetts Permit No.: cZ--3�t-�'5'2
Lu . �A - -_ Occupancy and Fee Checked:
!- ;;��_��"_ � Department of Fire Services
' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
y``'.-o' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH • Date: 0?�/l0/23
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 02$ Y.-3 c 64,0 Unit No.:
Owner or Tenant: 'Tay cc. t IV e o/C 1 ee'..z•d l(: Email:
Owner's Address: SA4..4.F Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No Igl Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: IOC) Amps /2 ' /2 'O Volts Overhead a Underground 0 No. of Meters: /
New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
, Description of Proposed Electrical Installation: %fG 4 t .-0,4-
Completion of the following table may be waived by the Inspector of Wires.
_No.of Receptable Outlets: ((.7 No.of Switches: S Generator KW Rating: Type:.
No.Luminaires: 6 No.of Recessed Luminaires: . No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: 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.❑ Above-Grnd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
System No.Oil Burners: No.Gas Burners: Video S Y ID No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
-No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrica Work: 41004. (When required by municipal policy)
Date Work to Start: 07//SP-3 i Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1 0 or C-1 ❑LIC.No.:
Master/Systems Licensee: IM i`el-cc i S. ke/&G' LIC.No.: ,24 ti, ? A
Journeyman Licensee:
IAA.'c I.a a/ 5'. ke/rt e-- LIC.No.: 9''77 QE
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email: Telephone No.:
I certify,under the pains d p nalti �f perjury,that the information on thisth application is true and complete. •� a}
Licensee:
( /try./f"n Print Name: j/l/ttie e/3. tee,er- Cell.No.: 4/7^J•�X . 7//
INSURANC COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
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 office. Specify: •��• S
CHECK ONE: INSURANCE W. BOND 0 OTHER 0 g P fy:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the lia tlity insurance coverage normally
required by law.By my signature below,I hereby waive this requirement.I am the:(Check one)Owner 0 Owner's agent 0
Owner/Agent: Tel.No.:
Email.:
Signature:
7Scc_.