HomeMy WebLinkAboutBLDE-23-001100 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-001100
VBOARD 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:8/30/2022
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) 50 CARRIAGE LN
Owner or Tenant MACHNIK CRAIG T Telephone No.
Owner's Address MACHNIK TRACEY A, 50 CARRIAGE LN, YARMOUTH PORT, MA 02675
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters *,
New Service Amps Volts Overhead ❑ Undgrd ElNo.of Meters _e'
Number of Feeders and Ampacity . , . _ ` ij
Location and Nature of Proposed Electrical Work: Hot tub& low voltage lighting. 7
Completion of the following table may be waived t1se In pec�or of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of cf ,�'' Total
Transformers `.�,: KYA
No.of Luminaire Outlets No.of Hot Tubs 1 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. Ton I No.of Alerting Devices
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((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 ofperjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Arturo Rodriguez Signature LIC.NO.: 56763
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:84 Devon Lane, Marstons Mills MA 02648-1894 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
Telephone No. PERMIT FEE:� j $115.00
A/A. t2/z./22 AC G.Nc"1 3A.i., i A-i 3J /do (JErtido,)6/ %3n`!'-IC_? Sre L,cw-rs ? /2/�I 4.J' .
•
RECEIVED
AUG 2 9 2022
BUILDING DEPARTMENT
'By: official Um /�
O —�--- �'�ronw..�/t m�//lewarl�.eb r A.
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v `�eparGm.mt o/s.�ire Permit N
a
�n�. Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS `Rev.1th7] (tmoeblmk)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
An pule to be perforated in.ccwdmce with the Massachusetts Electrical Code(MEC).527 CMR 12.00
b (PLEASE PRINT IN INK OR t"PE ALL INFORMATION) Date: 5/Z 9/Z 2
City or Town of: (r- ,q,itt To the Inspector of Wirer:
€ By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
S Location(Street Aiye�tuber) J(✓ C c.,r r,C.
♦ Owner or Te000t j I q C q r Vt.. ( r-.I G T Telephone No.
w Owner',Address O ('., `./o 1 .rtioaJ o`'.Ail 02 L•�
Is this permit In with o WalingYm❑ No El (Check Appropriate Box)
' Perpove of Boildl ',ci r',i I ,I1 Utility Authorization No.
Existing Service Amps I Vohs Goatee 0 Uodgrd❑ No.of Meter
New Service Amps Vohs Ossohsed❑ Undgrd 0 No.of Meters
Nomber of Feeder and Ampocitv T ` 1 ( 1, 1. 1-
Location and Nature of Proposed Electrical Work:V.;]y e. Na4 1 ti r1 Qco C1 d P_Ck.low YD little_ I Iqn s
'5 Completion of Me(ollowingtableecy be waived by tMfntpodorofW el J
or Total
In No,of Recessed L.mloaire, No.of Cdl.-Snip.(Podd Transformers VA
e)Pam No.
Z� KVA
Q. No.of Luminaire Outlets No.of Hot Tubs `I Geeenton KVA
Above In. No.tat Emergency Lighting
4- No.of Lumlodm Swimsstsg Pool Red ❑grad ❑ Bantry Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of C Boer No.of Detection and
Gasnn
Initialing Devices
and
No.of Ranges No.of Mr Coed. Tons No.of Alerting Devices
Na of Wrote Hart Pomp I Nam_berIem IKW_ No.of Self-Cootdeed
Totals: Detection/Alerttl Devices
No.of Dishwashers SpoceiArea Heating KW Loral❑Myy o kl o ❑011ie
No.of Dryer. Hating Appliances KW No.of Devlees'or Equivalent
No.of Weer �, No.of No.of Dots Wiring:
Heaters Ballasts No.of Devkeo or E uonsriIvseaglent
No. r Hydromeege Belklobo No.of Motors Total HP reIeNo.of ommu kn or Equlvaleet
OTHER:
Attach additional derail if desired ores required by the inspector of Wirer.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start Inspatioos 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® BOND❑ OTHER❑(Specify,/
1 certify,ands the pains end penalties of perjury,dent the b f rmation on tAit application is tree and complete.
FIRM N EL LIC.NO.:
Licensee: Slgumro ,y, Q ii•✓ LIC.NO.:5L-1 t"1-C3 3/
11Ifapplkab gp••exempt•.In dtq� �t�rEcI (1 Ban.TeL No:
Address: y U2vaH IM f 4 Sld'/S+"Ire II S.AA 0z648 Alt.TeL Pla• {
*Per M.G..c.147,a 57d1,security work requites Department of Public Safety 5"License: Lic.No. J 0
OWNER'S INSURANCE WAIVER:I am aware that the Licensee doee rot have the liability insurance coverage normally 7
required by law.By my signature below.I hereby waive this requitement.1 am the(check one)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$