HomeMy WebLinkAboutBLDE-23-004001 0, _ 4,n Commonwealth of Official Use Only
�; Massachusetts
Permit No. BLDE-23-004001
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:1/21/2023
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) 78 CAPT BESSE RD
Owner or Tenant CAMERLENGO LAWRENCE P Telephone No.
Owner's Address CAMERLENGO BEVERLY A, 78 CAPT BESSE RD, SOUTH YARMOUTH, MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriates Box)/
Purpose of Building Utility Authorization No. •2 _
Existing Service Amps Volts Overhead 0 Undgrd 0 rl`If et -1/7
New Service Amps Volts Overhead 0 Undgrd 0
Number of Feeders and Ampacity Q /if
Location and Nature of Proposed Electrical Work: Replacement HVAC&water heater.
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Completion of the following table may be waivetty ,1 ..ec of Wires.
N.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans
No.of
Transformers4.
No.of Luminaire Outlets No.of Hot Tubs Generators
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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 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 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water 1 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: Charles K Swanson
Licensee: Charles K Swanson Signature LIC.NO.: 12895
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:718 CEDAR ST, W BARNSTABLE MA 026681300 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: $50.00
Ci . ?(z3
Commonwealth o/?addachudettl Official Use Only
i t_ =E'/ cc�� cc77 Permit No. -13 ' O
mliiir S: eL)eparlment o/.}ire.erviced
__4{__ Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
(leave blank)
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: I/r1/2,3
City or Town of: •(0,1-moutAkiN 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) —IS l aoai,l. ?)e, s2 R
Owner or Tenant Lawcenc� Coumext,e t Telephone No.rjoB--1-110-`193C
Owner's Address J
Is this permit in conjunction with a building permit? Yes ❑ No p, (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service _ Amps / _Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: W i ring oc kwrnace 10.1r t �- 4\- o er \c.e
Completion of the following table may be waived by the Inspector of Wires.
No.ofNo.of Recessed Luminaires No.of Ceil.-Susp. Transformers KVATota(Paddle)Fans
KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
6
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
—Z No.of Switches No.of Gas Burners No.of Detection and
s Initiating Devices
ANo.of Ranges No.of Air Cond. Tonsl
A No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: 1 Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances 1 KW Security Systems:*
No.of Water No.of No.of No.of Devices or Equivalent
Heaters KW Data Wiring:
Signs Ballasts 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: i Ir2.00 (When required by municipal policy.)
Work to Start: i 11[2_3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COV RAGE: 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 [f BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: 1 - eS \--1eakin I 'n LIC.NO.:
Licensee: Orvate,5 K. SWOs.SOc1 Signature G IC.NO.: 1295 A
(If applicable,enter "exempt"in the license number line.) Bus.Te.No.: BoS-11G-3033
Address: 21 \ `(ACP(\OVV' t\ FZd,I LAyarni5 0490\ Alt.Tel.No.:
*Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE:$
Signature Telephone No.