HomeMy WebLinkAboutBLDE-23-005841 Commonwealth of Official Use Only
filfi,\ Massachusetts
Permit No. BLDE-23-005841
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:4/20/2023
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) 23 CAPT DANIEL RD
Owner or Tenant RYAN ALAN Telephone No.
Owner's Address RYAN MICHELLE A, 23 CAPT DANIEL RD, 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 r No.of ter
New Service Amps Volts Overhead 0 Undgrd 47• •.of t s
Number of Feeders and Ampacity Q
Location and Nature of Proposed Electrical Work: Wiring for shed with under ground. V y
•
Completion of the fol o �j",• %i • ,,,s• wa. he 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 gimp '.,0.) KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. ,Battery Units
No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 2 No.of Gas Burners No.of Detection and
Initiatine Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
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 Sins 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: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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
-- +renc read hin/0
RECEIVED
[...t PR 2 0 202�0 onwealth of Massachusettsel--MU
*_ Permit No.:
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=''w1 ` 7 DEPARTME •artment of Fire Services Occupancy and Fee Checked:
ti- =►-1= -�- :s _ : i e : IRE PREVENTION REGULATIONS [Rev. 1/2023]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 CNA 2.00
City or Town of: YARMOUTH Date: Vi /'f Zo -z 3
To the Inspector of Wires: By thi a lication,the undersigned gives notices of his or her intentionen to perform the electrical work described below.
Location (Street& N mber): 3 C 47 Y v OK/Al /.6 (. i'�-,(/ Unit No.:
Owner or Tenant: .1 L # 6 Email: .
Owner's Address: IL CA-Pi g N , - / r r / Phone o.:
Is this permit in conjun tion w.th a uil g ermit4heck appropriate box) Yes No ❑ Permit No.:& -t 2-2 — 006 93
Purpose of Building: Si 91 Utility Authorization No.:
Existing Service: Amps . / Volts Overhead 0 Underground ❑ No. of Meters:
New Service: Amps / Volts Overhead ❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: /�" �[' wire. S' `-,l #
1il i `fit LhtioigA
Completion of the following table may be waived by the Inspector of Wires.
No. of Receptable Outlets: No. of Switches: Generator KW Rating: Type:
No. Luminaires: / No. of ecessed Luminaires: No. Wind Generators: Wind KW Rating:
No. Appliances: KW: No. Water Heaters: KW: No. Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No. Motors: Total HP: Total KW:
No. Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No. of Devices:
Swimming Pool: In-Grnd. ❑ Above-Grnd. ❑ Hot-Tub ❑ No. of Self-Contained Detection/Alerting Devices: _
No. Oil Burners: No. Gas Burners: video System No.
of Devices:
No. Air Conditioners: Total Tons: Telecom System 0 No. of Outlets:
No. Energy Storage Systems: KWH Storage Rating: Security System 0 No. of Devices: _
Solar PV KW DC Rating: Solar PV KW AC Rating: No. of Electric Vehicle Supply Equipment:
No. of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 ❑ Level 2 0 Level 3 ❑ Rating:
OTHER:
1 o utr o 5 c (_ e 1 i Ovtp-(_Ae Itynf- ' 2airs,gc F i
Attach additional detail if desired, I.,' required by the Inspector of Wires.
Estimated Value of Electrical Wor ./) _:cE?� 5-W (When required by municipal policy)
Date Work to Start:Apr", i. -I' Inspections to be requested in accordance with MEC Rule 10, and upon completion.
FIRM NAME: A-1 ❑ or C-1 0 LIC. No.:
Master/Systems Licensee: LIC. No.:
Journeyman Licensee: LIC. No.:
Security System Business requires a Division of Occupational Licensure"S" LIC. S-LIC. No.:
Address:
Email: Telephone No.:
I certf, under the pains and penalties of perjury, that the information on this application is true and complete.
Licensee: Print Name: Cell. No.:
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee
provides proof of liability 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:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance c erage normally
required by law. By sign ,tur elo he eby waive this requirement. I am the: (Check on Owne w '
Owner/Agent: �ji Tel. No.: •
Signature: Email.:
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