HomeMy WebLinkAboutE-19-2642 s��% (7' Commonwealth of Official Use Only
✓ �.T►\ Massachusetts Permit No. BLDE-19-002642
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:11/1/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform he leptri I yvojk descrjljrA-}�clgw.
Location(Street&Number) 13 CARTER RD //fit /�4�C/—• t�lpTll/.Lh }t�A/IV/
Owner or Tenant FITZGERALD EUGENE C Telephone No.
Owner's Address FITZGERALD MARIETTA, 13 CARTER RD,SOUTH YARMOUTH, MA 02664-4405
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 0 Undgrd ❑ No.of Meters
New Service Amps Volts Overhead El Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Recessed lights&receptacle.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 3 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 0 In- CINo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 1 ' 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 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 Data Wiring:
Heaters Siens Ballasts 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 th such
coverage is in force,and has exhibited proof of same to the permit issuing office. 519r
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) Sq-- DMI certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Charles L Stone
Licensee: Charles L Stone Signature LIC.NO.: 22556
(Ifapplicable,enter"exempt'in the license number line.) Bus.Tel.No.:
Address:240 ALGONQUIN AVE,MASHPEE MA 026492814 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
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No." PERMIT FEE:$7100
et600 (r/2/t8i
14 A ( 1 i4 lie Ka_
i .k l--Ito(te cF----
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- S • • . Luaus murealsls of Mamaefurse f3 • 'ot6cial a Only ' . .
•
2' .:674.1 as Seraica4 P No_ •� CZG�•
\ = $ • Occngmcyandlteerhrticrd '
BOARD OF FIRE PREVEN11ON REGULATIONS • Eta I/07) atm bink) '
• • . -• APPLICATION FOR PERMIT TO•PERFORM ELECTRICAL:WORK .
' ' . • •BIIwodciobeperthmedlimeartaocewlgiBieMamirtn.. mnekialCods Qfg12.00
_ -"•-•• _ • ... ----list S'dSFPR1NTININ% =EL II
vR �OULIZIT NJ'. __b y_—/ ./
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•Ctyor a Vvalle/ . TatheL ed6rofYYrres:- • •
By4rilappliicabon the andeasignedgivtnotice ofhisor her mteahontopafefrm lie e work descanted lielaww
Q • • location(Street&Nmmiber) •/3 Crtsz { evi....te �'
V� • Owner or Tenant,./V)Arta ne%y .3•dephaneNo.
c/)' • :Owner's Address •54J•neti /f=rlQO/
•
��q •' . istbispermit brconfoaetionlen tb¢Ildingpern�?. Yes, No Q . (CfieckAppropriateBoia /��31 '
J: • ' .. . •ProposeofBmld'mg 3/ k ze `ise..r`. . ! .BettyAathorleafonNo. • •-
Q i ;Da A1Secviee_ / • Va crhead0 •Magri0 . ' : •
s •
W 2 ew$evfa • 'Amps • • Volts • •Overhead 0 . Magid Ne.of Meters _ -
> '9N 4 1 nucberofPeedersandAmpatity. • • .. .
.- �, W •cation andNati eofPioposedElectricalWork '' .
11111 O ° . . . ,. . •
: •
o `Ik o i •
Completion of theathavalie may be w:ivy:E by the bupedor ojiYaet
111% o a of Recessed ; a n 3 • NaafCetl. sp.(Paddle)Fans • 17sasfbrmers ••: Teta-KVA • •
Cd ' m •aoftorainaireOutlets. • Na of Hot Tubs • ' ` Generators •
• KVA ••
Na ufl mMatres:_ . ., tool-Above fgerge°egLgbhng "
Sw�mmg _
. 'LT':- .•.• . •
_ £j dc• • end Batfixry Units
• No.of Receptacle Outlets .` f • Na of Oi1Bmaers. -k7RE,ALARMS No.of Zones •• • •. . .
Na of Switches Na of Gas Blanca • •No.ofbetection sad •
IniSathrl Devices
No.of$angn • Na of AirCond. TonsNa of AlertimgDevicis •
• No.of Waste Disposes - . Pomp Number Tons KRt No.�Sel nfamed -
. �yi nemirm�gDevirrs
No.ofDishwashers . Space/AreaHeaimg KW • Local(1=am 0 Other •
'
s
Na of Dryers � EAPPrianeesa ICW . S ofY7evieeaorF.gr¢valent
Na of Water KW
No of . No.ofData wring:
• Signs NaornevIeesorEgnivaleat •
aters
..• •. (Na Hydromassage Bathtubs No of Motors • TotaMHP Te rim&De callous W - -
1 Na ofDeviees orFeat
i1HER: • 13/;r..i'FI ells/
- Attach addidaneldeaalrk eralrequired bythe htrpecmrerns. •-
' • Estm *d Value ofElecttiealWo± • 2 if.... (When regmredbymunicpa1po y) .
•. Wain to Start: ; / /f Inspections to beregoeslEdm a cew MEC Bale 10,=laical completion. '
INSURANCE G Unless waived by the owner,no pfatbepalU eofelecricalworkmay.issueunless . :•
the e>;CertSeeprovidesproofofliabiityinsmaaceinclading'campletedoplrationa eery mega ori iiibstargalegnioalent. The
. de edtss ris littera slaw edproofi. �embep�tit gS . . •
r
nthat m
_ _ . •.. .. aEaroistaalsoxnxce Er:BoD 0 . canrit0 (Sperm) ' - . ., •- • . _ _ •. . _ - .
' 1 cerfrip,under fix pates erapenaidevofperjivy,Oust s et:formation on this apprua on is tate mrd complete
• • FERAMNAME:• . • '.: - _ - 1%04 • - •/. LIQ NO.i Q Z�s� :
• U C "'1-, f .iw Srgaatnre ,. ' ural ' allo.: ,p�4" . -
• ' {Ifappl*rSin•oner"ec®r* rnthefeouemmtberlow,f. • Bra.TeLNo.• . s:l,.•1
.' ' . Address:: 2110 fi$a ,</4/ t , rl/�f5 roe ' AMG Tel.Nei.: 9IQ/ •
•. *Pet LGL e.147,s.5761,sway work=pines Department ofPobhe Warr License: Lit.No.
• • OWNER'S]N UItATTCEWAfltR Iamaware.tbatthe Licmdadoes not hare thefatality insurance coverage normally
ratio/way kw,By my signnbelow,Iherele ve tbii TequirementIamthe(cherkrone)Downer ❑owner's agent.
Owner/Agent
• • Signatare-- Telephone Na . . ' 'FIER T.FEE:$ -26771 -