HomeMy WebLinkAboutBLDE-22-005690 Commonwealth of Official Use Only
:ft'4 II Massachusetts Permit No. BLDE-22-005690
"""' ,' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
jRev.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:4/5/2022
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) 57 WHARF LN f `
Owner or Tenant WILKINS ROBERT Telephone 1>6s:••, � •t ,
Owner's Address COURCIER SUZANNE, 57 WHARF LANE, YARMOUTH PORT, MA 02675 e.r\��4ji\ �',\J.>
Is this permit in conjunction with a building permit? Yes 0 No 0 (Checlr ti a'at�gx)<;
Purpose of Building Utility Authorization No. \3 `,�i, ) 'NI `1
Existing Service Amps Volts Overhead 0 Undgrd 0 No.af'11Met". , ti; ; •;.),
New Service Amps Volts Overhead 0 Undgrd 0 No.of Mofot \f .. A
Number of Feeders and Ampacity 1, `�L fir;, V
Location and Nature of Proposed Electrical Work: Install generator. ) N',"
j )J
Completion of the following table may b f y t 44fs ctor 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 1 KVA 20
No.of Luminaires Swimming Pool Above ❑ In- ElNo.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. Tons 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 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 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: Marcelo R Soares
Licensee: Marcelo R Soares Signature LIC.NO.: 13036
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:53 FALMOUTH SANDWICH RD, MASHPEE MA 026494307 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
C6 No ur r 4/7/
RECEIVED
APR 05 2i.�, _ -_ k ¢r i 7 1.. 1 ti
Ilets 3a.t _N � '1 f�s1EDING DEPARE �
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
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. OWNER'S ThTSTIRANCR WAt V A& I a a mart that thn Lama Lama=dams:not have the liability iusman=cavq;.-normally
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