HomeMy WebLinkAboutBLDE-23-004575 �,� Permit No. BLDE-23-004575
+_�� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.l/071
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
ASE PRINT IN INK OR TYPE ALL INFORMATION) Date:2/17/2023
City or Town of: YARMOUTH To the Inspector of Wires:
is application the undersigned gives notice of his or her intention to perform the electrical work described below.
Ilion(Street&Number)60 BAYBERRY RD
ler or Tenant Steve Netzel Telephone No.
ier's Address
is permit in conjunction with a building permit? Yes❑ No 0 (Check Appropriate Box)
rose of Building Utility Authorization No. 1 20 3 001-1 2z✓
ting Service Amps Volts Overhead❑ Undgrd 0 No.of Meters 5'A-no.2.cC°
Service Amps Volts Overhead❑ Undgrd 0 No.of Meters t4 ..g g'j j+
iber of Feeders and Ampacity
ttion and Nature of Proposed Electrical Work: 100 Amp overhead temp
Completion of the following table may be waived by the Inspector of W
.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
T..e...f......e..c Iry A
of Luminaire Outlets No.of Hot Tubs Generators KVA
of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of Switches No.of Gas Burners No.of Detection and
of Ranges No.of Air Cond. Total No.of Alerting Devices
of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Tnmlo• ne.a../:..n/A lo.l:nn hnv:nnc
of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
of Dryers Heating Appliances KW Security Systems:*
V..of nnv:nnc n.cn..:.,alnn.
of Water KW No.of No.of Ballasts Data Wiring:
Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
HER:
Attach additional detail if desired,or as required by the Inspector of t
noted Value of Electrical Work: (When required by municipal policy.)
k to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
URANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee providt
f of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is i
and has exhibited proof of same to the permit issuing office.
•
:CK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:)
rift,under the pains and penalties of perjury,that the information on this application is true and complete.
M NAME: ALAN R O'REILLY
nsee:Alan R O'Reilly Signature LIC.NO.: 51570
plicable.enter"exempt"in the license number line.) Bus.Tel.No.:
ress 12 LENTELL ST,SANDWICH MA 025632116 Alt.TeL No.:
M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License:
NER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But tr
hire below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent.
ier/Agent
ature Telephone No. PERMIT FEE:$50.00
14
RECEIVED
FEBC.L6 2023 ,ommonwealth of Massachusetts Official Use
Only `ls
_= 1 Permit No.: 2
BU. = ! .e R IMENT Department of Fire Services Occupancy and Fee Checked:
`'- : : : OF FIRE PREVENTION REGULATIONS 1
ABL
ey __ .i _;.,__�� Rev. I/2023]
yN" APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 M 12.00
City or Town of: YARMOUTH Date: 02 /6 J 3
To the Inspector of Wires:By this application,the undersigned gives notices of hisior her intention to perform the electrical ork escribed below.
Location(Street&Number): t ,0 ct be ter%1 Ic.oc,..\ Unit No.: i
Owner or Tenant: S H Z e Email: 7S L h e {-?_ - 11a1-wt.y.,__I •_C_'w+ j
Owner's Address: 5 c.-k.wkf___ c s ti,10--,•r-C, Phone No.: tik-) .5`i . 5:,1 S,
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit o.:
Purpose of Building: �l ewe p ;),'�...rrsr Utility Authorization No.: 11O'CO
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: 'fir.S 4K ( ( ( OOct,, t f ra 17J-k-r IA ec d -re w 1
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 Recessed 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❑ 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❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ 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❑ Level 1 ❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electric Work: O (When required by municipal policy)
Date Work to Start: 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: (..A-(p i1 � c I e_c `c.a/J A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC. No.:
Journeyman Licensee: z 5 ( r 1 0 LIC.No.:
Security System Business requires a Divisionio of Occupational Licensure"S"LIC. S-LIC.No.:
Address: f 9 L c.A: ( ( S I i-e s ce.,AcLit L t 04,-A- (5 .-S-6J
Email: M0.v p e.A e c_ c_ 0 t o.t ( - Lot Telephone No.: CD�.) C,`'j r^- ?I r]
I certify,under the pains and penalties of perjury,that the infor ation on this application is true and complete.
Licensee: Print Name: r/T/ael Q ;j Cell.No.: CS_68)g ( c7/4 7
INSURA OVERA ss waived by the owner,no permit for the performance f electrical work may issue unless the licensee
provides proof of liability includi "completed operation"coverage or its substantial equivale t.The undersigned certifies_that such coverage
is in force and has exhibited p of same to the permit issuing office. �,
CHECK ONE: INSU C BOND❑ OTHER CI Specify: `T.z!'s /02. dt.3
OWNER'S INSURANCE WAIV R: 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. I am the: (Check one)Owner❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: