HomeMy WebLinkAboutBLDE-23-005842 , � to
Commonwealth of Official Use Only
(IL. ;,: Massachusetts
Permit No. BLDE-23-005842
....:.' 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 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and AmpacityE
Location and Nature of Proposed Electrical Work: Wiring for sunroom&spare roomCompletion I r • li/04#
d by the Inspector of Wires.
No.of Recessed Luminaires 4 No.of Ceil:Susp.(Paddle)Fans .f!i ' °i Total
f KVA
No.of Luminaire Outlets No.of Hot Tubs Generator O O KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emert 4
4.1,11bAth
grnd. grnd. Battery Units
No.of Receptacle Outlets 14 No.of Oil Burners FIRE ALARMS No. s Ws
No.of Switches 7 No.of Gas Burners No.of Detection and
Initiating 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 0 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 Siens No.of Devices or Eauivalent
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 ❑ (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
.� Rfn
of Official Use 6i
4 ' 0 o wealth Massachusetts 4le-* - - ,R2Permit No.: 'rl�ij
-__0i0;__. D .rtment of Fire Services Occupancy and Fee Checked:
=�- -" PPAR rF I E PREVENTION REGULATIONS [Rev. 1/2023]
"''------- • - ' • ON FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC) 527 C 12.00
City or Town of: YARMOUTH • Date: . C1 '2.3 ,
RMOU t
To the Inspector of Wires: By this cation,the u dersigned ivl:/9TJ1(
otices of his or '�f in ntion to perform the electrical work described below.
Location (Street & Nu ber): /rV L —�(/ Unit No.:
Owner or Tenant: L �- Email: AUM/� /¢l 3 5M / �'�
Owner's Address: )_3Gf� �7 IJl nl i� Phone No.: 7-6P 1 6 ' 6 7 goZ
Is this permit in conjunction with a building permit? (Check appropriate box) Yes [71/No ❑ Permit No.:/;i ZZ — Cb3 6
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead ❑ Underground ❑ No. of Meters:
New Service: Amps / Volts Overhead ❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: V " ire )(Akvro u rl'1 ( .5)9A ►' (0 Yvk .04Vel:fi,
Completion of the following table may be waived by the Inspector of Wires.
No. of Receptable Outlets: 1114c No. of Switches: Generator KW Rating: Type:
No. Luminaires: No. of Recessed Luminaires: No. Wind Generators: Wind KW Rating:
No. Appliances: KW: No. Water Heaters: K : 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 ❑ No. of Devices:
Swimming Pool: In-Grnd. 0 Above-Gmd. 0 Hot-Tub 0 No. of Self-Contained Detection/Alerting Devices:
No. Oil Burners: No. Gas Burners: Video System ❑ No. of Devices: ,
No. Air Conditioners: i otal 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 ❑ Ground-Mount 0 Level 1 0 Level 2 ❑ Level 3 ❑ Rating:
OTHEItik_ L -1L
_00 15/A, el— i 4-- 0 L4 /Attach additional detail if desired, s required by the Inspector of Wires.
Estimated Value of Electrical Wort: CO (When required by municipal policy)
Date Work to Start:*f. �- Inspections to be requested in accordance with MEC Rule 10, and upon completion.
FIRM NAME: A-1 ❑ or C-1 ❑ 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 certify, 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 ❑ BOND ❑ OTHER ❑ Specify:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance c verage normally
required by law. By my si a below I hereby waive this requirement. I am the: (Check one) Owner Owner's agent El
Owner/ Agent: ( f / Tel. No.: g
,
Signature: tk Email.: ,
eli'i .