Loading...
HomeMy WebLinkAboutBLDE-23-005329 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-005329 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 PR/NT/N INK OR TYPE ALL INFORMATION) Date:3/29/2023 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 de cri d below. g Location(Street&Number 98 HIGHBANK RD 6 e Owner or Tenant EVAN SAURETTE Telep one No. Owner's Address 98 HIGHBANK ROAD, 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 ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement devices and fixtures. 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 22 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 12 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal 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 ❑ 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 ❑ 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: Evan Saurette Signature LIC.NO.: 56412 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:50 Reid Avenue,West Yarmouth MA 02673 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 cCii, ` /2(23 ails ors (Ai 10 04 Con N nail out V) udt 1?-.CA-0 ) N ` CEIVED �`'._� •mmonwealth of Massachusetts Official Use Only__-* _- - 2023 Permit No.: ��23� ��J L -__.' _�>�►_—; Department of Fire Services Occupancy and Fee Checked: �' B Y kb OF FIRE PREVENTION REGULATIONS Rev. 1/20231 �- °rf— =�` APPLICATION 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: /or,-b , g'.,� To the Inspector of Wires: By this application,the undersigned gives notices of his or her intention to perform the electrical work described below. Location (Street& Number): 9 g Ho bank Unit No.: Owner or Tenant: pv/Uh 91,i rC /-j Email: 5qurc0•pe K ( ymy./,-eo/rl Owner's Address: SO ge-h G it to wo-54- �-r Maq 11) A44 Phone No.: 7?// —14 v �L} yt-f Is thispermit in with a building appropriate Yes ❑ No 0 Permit No.: conjunction (Checkbox) Purpose of Building: re h FcfI Utility Authorization No.: Existing Service: Amps / Volts Overhead 0 Underground 0 No. of Meters: New Service: Amps / Volts Overhead 0 Underground 0 No. of Meters: . Description of Proposed Electrical Installation: S i,vgp t7 ?- p I sty / S v 1 l,c/J'S cn d 1,41- Completion of the following table may be waived by the Inspector of Wires. No. of Receptable Outlets: a a No. of Switches: 1 Generator KW Rating: Type: No. Luminaires: C' 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 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 0 Level 2 0 Level 3 ❑ Rating: OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: I4 1/OO'D (When required by municipal policy) Date Work to Start: Marc h i/ a i Inspections to be requested in accordance with MEC Rule 10, and upon completion. FIRM NAME: _ A-1 0 or C-1 0 LIC. No.: Master/Systems Licensee: LIC. No.: Journeyman Licensee: E von Su re-1fe LIC. No.: S C. LHa B Security System Business requires a Division of Occupational Licensure"S" LIC. S-LIC. No.: Address: 50 �e:d cive 'S/ )G lYY1 t1 ) 414 0..)4;2 . Email: Seru k'ef i e'e 1/Ah 07mcr1`) ► Co/h Telephone No.: 7 ?t 4 8'? vl,5,7G( I certify, under the pains and penalties of perjury, that the information on this application is true and complete. Licensee: Bl/un urr°I4e Print Name: EL'ai Sqq 1D/ C Cell. No.: 77t-- t 7 57u 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 0 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 ❑ Owner/ Agent: fZ1/Cfn 5ctii re I- € Tel. No.: 7 24 ~ ti0 7- l.f.c 741' Signature: ckva U 4. i i, _, Email.: i rr/-1 P eVan'y jylci;1 (a/yi 46'0 if CAS