HomeMy WebLinkAboutBLDE-23-002948 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-002948
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:11/29/2022
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 BARNACLE RD
Owner or Tenant NICK PAPAKYRIKOS 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: Inspection for service to restore power.
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
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. Ton l 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 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 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:
Licensee: Troy Hines Signature LTC.NO.: 56707
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 482 Prospect Street,Methuen MA 01844 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 EE: $50.00
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RECEIVED R -(�(. /
9 NOV 29 2022 A� yy� /
L - Commonwaa/h o/rrtmdachudeltd Official Use Only
>I-x--car,"si;_ ecms// (/`1� Permit No. r/ /- .I`'t.
er.—
ararinsed of Jw Serviced
1i BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
-. [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: //- 9-a a,
Cityor Town of:
�— YARMOUTH To the Inspector of Wires:
By this application the undersigned gived notice of his or her intention perform the electrical work described below.
, U Location(Street&Number) /S q / p
/?GrnG(IQ t�QG
4 Owner or Tenant 'I/CI( f,^eA Kyrtkei Telephone s
/ P �6�-ex2-y /9
Owner's Address /S /3,rhac(p /ZeAd
Is this permit In conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
c Purpose of Building Utility Authorization�,ET--
i+ Existing Service/b U Amps (Zr)/aUo Volts Overhead ElE]Undgrd No.of Meters Z
New Service Amps / Volts Overhead❑ Undgrd\Zt
g ❑ No.of MetersNumber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ('7,0% a,,) 4,xfer,or
Completion of the followinglople may be waived by the Inspector of Wires.
tit No.of Recessed Luminaires No.of Cell-Snap.(Paddle)Fans N°'°f 7 oral
Transformers KVA
Ci No.of Luminaht Outlets No.of Hot Tubs Generators KVA
4: No.of Luminaires Swimmin Pool Above In- No.of Emergency Lighting
g Ernd. ❑ grid. ❑ Battery Units _
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
ri No.of Switches No.of Gas Burners 'No.of Detection and
< Initiating Devices
Ill No.of Ranges No.of Air Cond. Total No.of Alerting Devices
No of Waste DisposersHat Pump Number,.Tons._KW _ No.of Self-Contained
Toffs: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Munic
P Local❑Connection ❑other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Aydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
/ // No.of Devices or Equivalent _
OTHER: /n S..044/h (Yr)'lt)rV ein e/-eci,-,,I,( v-',e
Attach additional detail if desired.or as required by the Inspector of Wires.
Estimated Value of Electrical Work: S d Z).Q 0 (When required by municipal policy.)
Work to Start://-30-.2 a Inspections 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 liabilityinsurance including"completed operation"coverage or its substantial equivalent.The
undersigned certifies that such coy ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND El OTHER 0(Specify:)
I certify,under the pains and penalties of pedury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: /,'Oi Signature <<==�%� LIC.NO.:5-6/a 7
(If applicable,''t exempt"in the lie a number(hie.) //// Bus.Tel.No:R Cl.. op.$)7-c-,Address: a? P,-afer'7SfYeef 1.07 1,42n /1 CJ/299/ Alt.TeL No.:
°Per M.G.L.c.147,s.57 1,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. 1 am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$