HomeMy WebLinkAboutBLDE-23-005574 Commonwealth of Official Use Only
(tE. :s4;rt Massachusetts Permit No. BLDE-23-005574
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:4/6/2023
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) 44 MONTAGUE DR
Owner or Tenant BAISLEY DONALD C Telephone No.
Owner's Address BAISLEY CHARLOTTE,44 MONTAGUE DR,WEST YARMOUTH, MA 02673
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: Check house for code requirements and correct as needed.
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/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 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: Peter Peto
Licensee: Peter Peto Signature LIC.NO.: 14763
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 132 Wintergreen Ln, Brewster MA 026312258 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
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A' -6 2023
APPLICA 4e FOR PERMIT TO PERFORM ELECTRICAL WORK
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Eattlmawd Valuta Elecadod Woir: (Wks mane by r.nidpd policy.)
Work to Slert !sips:dons to be satpmrd in accordance wib MEC Rule 10.and upon completion.
INBURANCIZ Uais waived by the owner;no peeks afar the perl'oeoos o[deitiat work wary time unless
Ira hearse psvidee pewee liebaiy imam incl dit'IaaaphYd apeatloe commie or is solowaisl equivalent 16e
uniawaged coats Wet am*avenge is is lbw,rd Irsakrlild proof dorms to the permit issuing Mace.
CHBCKOWE:VISURANCE j3.BOND 0 OTHER 0(Speail):)
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*PerM.OL c.147,a 5761.many work noires Dsprsrrsdpebiic Way`8'limn: Lic.No.
OWNlE B INSURANCE WAIVER: 1 am aware dad tin Licensee dales not has lb liebiily iaenraoa cowmen rosmdy
redid by low.Bysgsilerrse below.I May mdsonit memieeewt•Isunsits all❑crow ❑ossrr's arms
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