HomeMy WebLinkAboutBLDE-23-000736 Commonwealth of Official Use Only
Ems, Massachusetts Permit No. BLDE-23-000736
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:8/12/2022
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) 21 GUNWALE WAY
Owner or Tenant VANETTEN ANN M Telephone No.
Owner's Address 75 BAY ST, BRONX, NY 10464
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) �r1.
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 HVAC.
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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Ton l 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: ANDREW M LEVESQUE
Licensee: Andrew M Levesque Signature LIC.NO.: 17318
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:461 LOWER COUNTY RD, HARWICH PORT MA 026461831 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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Occupancy and Fee Checked
,; BOARD OF FIRE PREVENTION REGULATIONS Rev.1ro7) ( yam)
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:8/8/2022
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)21 Gunwale
Owner or Tenant Van Etten Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volta Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: wiring for replacement HVAC
Compktion of the/ollowingcable may be waived by the&+vector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans To.of TransformersTransformersKVA KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires swimmingPool Agrba ❑ Ignr-ad. ❑ Bot toefr yE Umnertgency Lighting
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of GasBurners No.of Detection and
Initiating Devices
Tota
and
No.of Ranges No.of Alr Cond. Tonal No.of Alerting Devices
No.of Waste Dbpasers HesT can Number Tons ' No.of Self-Contained .
Detecdon/Aterttng Devices .
Muaic
No.of Dishwashers Space/Area Heating KW Local CIConneclttion ❑Other
No.of DryersHeating Appliances KW Security Systems:•
No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromauage Bathtubs No.of Motors Total HP Tel communi No.of Devic sons or Equrivalent
OTHER:
Attach additional detail if desired or as required by theInspector of Wires. E
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: inspections 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 j
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. 1
CHECK ONE:INSURANCE QC1 BOND❑ OTHER❑(Specify:) r
I card(),,under the pains and penalties of perjury,that the information on this application is true and complete. !
FIRM NAME:Harwich Port Heating&Cooling,LLC LIC.NO. 593 Al
Licensee:Andrew Levesque Signature �' LIC.NO.: 17318A
(If applicable,enter"exempt"in the license number line) (// mu.Tel.No.b08-432-89'iir
Address: 461 Lower County Rd.Harwich Port,MA 0' Mt.Tel.No.:
°Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
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.1 am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE:$5()
Signature Telephone No.
"*Please fax a copy back to us at 508-430-6075**
or e-mail to: keciahphcllc.com