Loading...
HomeMy WebLinkAboutBLDE-23-005701 _� r 'l�1 Commonwealth of official use only • AL., _` Massachusetts Permit No. BLDE-23-005701 537 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:4/13/2023 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) 32 WEST RD b i--1-j ('c) _ Owner or Tenant F) Telephone No. Owner's Address , 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: Wiring for small addition. 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 9'1 grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones L No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons Tota No.of Alerting Devices r No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained V Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other: a_ 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:) Gt^j r 6, ` 1 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. � FIRM NAME: DYLAN W ARSENAULT Licensee: Dylan W Arsenault Signature LIC.NO.: 53495 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:2900 CRANBERRY HWY,LOT 25,EAST WAREHAM MA 025381321 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 TIP A' Leal ClIeeibiS ee---) A 6( z g 60.9004 6/Af VEIVCD. K6-1+bk, -61-- gocA91,1 _ H--- ida �/; ! ��Official' sy�On�ly/� �'1 I i'Y/a6�ack oe f '7 / f� L_____-- _,_ w. _a_tisJ �orrsvnonuea ah a II Permit No. T! =— i..ire Service6 \r_ROecvouiploan7lcy CheckedAPR 12 -= ,.i_Ai ,==t, eparimzrrt o ar_d Fee _- -- EBUILDING DEPAf ' 9,q ; 80ARD OF FIRE PREVENT101� REGUL�^TkONS (leave blank) eY — ---_.. APPLICATION FOR PERMITTO PERFORM ELECTRICAL WORK with Electrical.Code(. C),5 7 CMR 12.00 All work to be performed in accordance Date: �Z Z�L� ALL INFORMATION) PLEASE PRINT IN INK OR TYPE A City or Town of: e Oil kl To the Inspector of Wires: iication the undersigned gives no-ce of his or her intention to perform the electrical work described below. By this app d Location (Street&Number)L Telephone No. Owner or Tenant oh OC I—, Owner's Address No (Check Appropriate Box) 3 is this permit in conjunction wit��h��a building g permit? es_Utility Authorization No. � Purpose of Building ^e .Cp._'��°I` 1 No.of Meters Volts Overhead❑ Undgrd❑ g Service Amps No.of Meters d Existing ` Volts Overhead'_._: Undgrd n � New_ See Amps �-- " Number of Feeders and Ampacity �.�„ * Location and Nature of Proposed Electrical Work: r bl. Completion of the following table may be waived by the 1 Total r of Wires. No.of KVA No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA Generators Q7 No.of Hot Tubs No.of Luminaire Outlets above — In- :'o.o •mergency lg. ng No.of Luminaires Swimming Pool arnd. I ' arnd. n Battery Units____ __----- S FIRE ALARMS No.of Zones jNo.of Oil Burners `��'No.of Receptacle Outlets Detection and et Dec INo.of Dec INo.of Switches \No.of Gas Burners Iia • Devices 74 all Total No.of Alerting Devices No.of Air Cond. Tons INo•of Self-Contained No.of Ranges I r I Tons IK'i'...........I Heat Pump I......................................... ........... Detection/Alertin6 Devices No.of Waste Disposers Totals: I No.of Dishwashers Space/Area Heating KW Local n Municipals Connection ystems:" Heating Appliances KW Security of Devices or E q uivalent No.of Dryers No.of No.of Data Wiring: No.of Water Ballasts I No.of Devices or E uivalent Heaters Sins Telecommunications Wiring: I T©tal HP No.of Devices or E s uiva'lent No.of Motors - No.Hydromassage Bathtubs �` OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. �. (Wen required by municipal policy.) Es Work to Start: o Electrical Work: _ upon completion. Work to Start: ( Inspections to be requested accordance ifort the performancee ofOl an electrical work may issue unless lCE COVERAGE: Unless waived by the°`Nne.r,not rrnieted operation"coverage or itsel substantial equivalent. The INSURANCE ili insurance including"comp- of liability n�Lr..-._Ce exhibited proof of same to the pernnit issuing office. the licensee provides proofin force,and has undersi�ied certifies that such coverage 0yDi� OTHER Ti (Specify:) CHECK ONE: t pain and ET Y u that the information on this application is true L complete. o�PO ete- �certify,under the pains and penalties of perjury, I _s r � LIC.N0.:5 FIRM NAME: Signatura s�� c �.sF.75i-13, Licensee: n 1{A n � E(1a�,f — Tel.No. enter "exempt"in the license numberline.) Bus..Tel.No.' (If applicable, AMP "� {,t/ T i ease: Te.No. Address: d work requires Department of Pubic Safety ape M.G.L. c. 147,s.A 57-61,CEsecurity ' rweer D owner's a nt. �vCE WAIVER: Tam aware that the Licensee does notThave the ,one)10�ance coverage normally OWNER'S law. By signature below,I hereby waive this requirement. I a__.the(check required by By my b PERMIT FEE: $ 5�� OwnerlAgent Telephone No• �b�X0 Signature