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Home My WebLink AboutBLDE-23-003012 Commonwealth of Official Use Only �•�''�g'.: Massachusetts Permit No. BLDE-23-003012 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:12/1/2022 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) 15 BURNING TREE LN Owner or Tenant MIDURA THEODORE A Telephone No. Owner's Address MIDURA BARBARA L, 15 BURNING TREE DR,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 ❑ No.of At t New Service Amps Volts Overhead 0 Undgrd 0 . No.of . Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install generator Completion of the following t ble=may be waived by the Inspector of Wire No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of •Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 14 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting y 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 Initiatine Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices _ No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 Siens 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 Win 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: FRANCIS D JONES Licensee: Francis D Jones Signature LIC.NO.: 13534 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:309 Neck Rd, Rochester MA 027701700 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: $80.00 ,: , S . • l,ornmonweaGth ol/Y! `�"� , a66ac u6ett� ial Use Qnly 0` zent o/,.tlre�erulcee Permit No, �7i7 0 l Z- 6 3epar/r lf s> BOARD OF FIRE PREVENTION RCGUI_ATIONS Occupancy and Fee Checked • GReV' 1/07] leave blankAPPLICATION FOR PERMIT TO PERFORM El � ) All work to be performed in accordance with the Massachusetts Electrical Code NEC),5 7 CM2,00 WORK (PLEASE PRINT.W INK OR T.I.. .4 L I FORMATION) Date: / g By this application the undersigned give s Lice of his o her inters ion to performInspector^of Wires.' Location(Street&,Numb r). — !' n the electrical work described below; I Owner or Tenant U �+)Owner's Address e- rec.. I�pC ne No, , Is this permit in conjunction with a building permit? ' Yes Purpose of Building --- N0 (Check Appropriate Box) 'Utility Authorization No, Existing Service Amps / _ _._.____.`____dolts Overhead ❑ Undgrtq No,of Meters New Service Amps / 1 Number of Feeders and Ampacity Volts Overhead _ Undgrd❑ No,of Meters Location and Nature of Proposed Electr mai yorlc; � Completion o•the fol/owi table may be waived by the Inspector of Yytr•es, IN No,of Recessed Luminaires No,of Ceil,-Susp,(Paddle)Fans K l o,off` No.of Lutninafre Outlets Transformers KVA No,of Hot Tubs Generators TVA No:°f r,,amfnaires Swimming Pool : ?ove ❑ n. at e 'Units geucy�,tg remg _ } No,of Receptacle Outlets t nd' r rad, Batter Units No,of Oil Burners FIRE ALARMS No,of Zones No,of Switches - --- No, of Gas Burners .o etec ton No,of Ranges "- Tnftfatfn Devices ---- _ __ No.of Air bond, °�� an � No,of Waste Disposers eat' um j Tons No,of Alerting Devices p um ei ons rr et owe - ontatne Totals; ,. .,,,•„�,.,•,,,�,•,•,•,,,••,,.,,,••,�,•,,,,,,,., No, of Dishwashers Deteetfon/Alertin Devices Space/Area Heating NW Local❑ unicipa No,of Dryers heating Appliances Connection ❑ Othor' o,.o ater "` KW echo,o ystems;TM Heaters • KW `a •o �o,o e of Devices o�equivalent Suns Ballasts • Data of Devices No,Ilydromassage Bathtubs No, of Motors Total HP No,of Devices or E uivalent Te ecommuntoattons• rr ng; . OTHER; No,of Devices or E uivalent • Estimated Value of Electrical Wor ; i (When required detail{municipal li ns redadred by the Inspector of]Ylres, Work to Start; � �•�— required by municipal policy,) INSURANCE COVE RA ); nIInss waived sections to be requested in accordance with Ma;Rule 10,and upon p n completion, the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.by the owner,no permit for the performance of electrical work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CI- cK ONE: INSURANCEq valenf, The I certify,under the pains and penalties BOND ❑ OTHER ❑ (Specify:) •, FIRM.NAME; 0l e' f eijuiy,that the infor'nzatton on this application true and complete, 'll Licensee; -. ��j (� ------__ LIC,.NO.,; �`'rde` afappllcab7e,eater "e•eblp't"!n the license harm er line, Signature w�! Address; `' ` 1 �.LIC',NO,, 1 . • "Per M,G,L,c, 147,s,57-6I,security work requires Ct partment o•Public Safety License: Bns.Tel No,; OWNER'•S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage no ah Lie No,required by law, By my signature below,I hereby waive thisrequirement, I am the(check one ❑owner y i • Owner/Agent Signature _____ � [7 owner's spent, Telephone No, � RIl�7TFEGr , I