HomeMy WebLinkAboutBLDE-23-005173 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-005173
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:3/21/2023
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) 38 BRUSH HILL RD
Owner or Tenant PHELIPE GENEROSO Telephone No.
Owner's Address 38 BRUSH HILL RD,YARMOUTH PORT, MA 02675
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) A t
Purpose of Building Utility Authorization No. 12363929 "�`
Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters ��lli
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Check service after fire.
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
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/Alerting 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: JOSHUA B DEJOIE
Licensee: Joshua B Dejoie Signature LIC.NO.: 53490
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 10 LEXINGTON LN,YARMOUTH PORT MA 026752437 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
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-_ RECEIVED
' ► Official Use Only
20 nm wealth of Massachusetts Permit No.:Js�3—jl
I — r Dep rtment of Fire Services Occupancy and Fee Check _
.g'''„,_=• �0 TO I E PREVENTION REGULATIONS [Rev.1/2023]
''—'r. APPLICA ON FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date: 3—a.0-a•
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perfonn the electrical work described below.
Location(Street&Number): 35 b'CV S1\13t 11 R`A Unit No.:
Owner or Tenant: ( ¢-1 kp t 6 a f1 e co',o Email:
Owner's Address: 3 ,?>oi ry tVs1\Q.o al, Phone No.:
Is this permit in conjuncOon with a building permit?(Check appropriate box)Yes El No❑Permit No.:
Purpose of Building: LA t\VIVI Utility Authorization No.: I a. .,(p 39 aci
Existing Service: I O O kmps /_Volts Overhead❑ Underground 5, No.of Meters:
New Service: Amps / Volts Overhead El Underground No.of Meters:
, Description of Proposed Electrical Installation: ONe,C,`/ ?o,ttel i- 1Att0c a + C '(-‘'if..
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-Good.0 Above-Grad.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 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❑ Ground-Mount 0 Level I❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as re aired by the Inspector of Wires.
Estimated Value of Electrical Work: DO (When required by municipal policy)
Date Work to Start: 3-ao-a.5 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: -Sc IA'\vG. s 3e,t ``f-A Xkr A-1 0 or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.: •
Journeyman Licensee: Jn'\\U 6, G5o-‘E LIC.No.: 5 3J-i9 0-1j
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: B Ca(;4(..ic\ DOA-tt( P\c�, 5-yichO MFt Od.64k1
Email: A\cic.VI,1i(' F,tc-4\-ic4A 2)(.. '\c.. \ Lo Telephone No.: 11-11A. ' 10983
I certify,under the pains 0.e....1)
aa\nd penalties of perjury,that the information on` this pication is true and complete.
Licensee: 7o' .-oc. V�Y)i e Print Name: JGSt1V c.,V e Jt C Cell.No.: y 99L 0 t{83
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 IZJ BOND❑ OTHER❑ Specify:
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.I am the:(Check one)Owner❑ Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.:
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