HomeMy WebLinkAboutBlde-18-006548 Commonwealth of Official Use Only
fL. Massachusetts Permit No. BLDE-18-006548
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:5/22/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 881 ROUTE 28
Owner or Tenant GREEN CAVALIER LLC Telephone No.
Owner's Address 111 HUNTINGTON AVE#600, BOSTON, MA 02199
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 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: Ufer groundirr' . , iD...i.NG 8)
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
Initiatine_Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
fto"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 ❑ 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 Sins 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 that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE 0 BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Arthur P Doherty
Licensee: Arthur P Doherty Signature LIC.NO.: 17197
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:372 YARMOUTH RD, HYANNIS MA 026012043 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) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
g.A Comnwnwsatth o f Maettachuosits Official Use Only �J
_tt��� Permit No. "/e ‘S L7
•paPtn sat o f Serviced
r.', tom,' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
q All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,�/�/,/$
vCity or Town of: la,i'N•t Olti To the Inspector of Wires:
By this application the undersign gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) Fel 7Q U. o2�
Owner or Tenant (y/'Q.erl CCi,.►V4-/I>�' L.LC Telephone No.
v); Owner's Address //I Hitil-f rqtpfl 1 1/� /,QO J3OS`�'V✓1 MA t��-/99
4' Is this permit in conjuncts n with s uilding permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building CQ jn/ne f'c( I Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
v New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Ti IAA IA i n q 'R 14,- rQ rQ1,th
,J J
° Completion of the following table may
be waived by the['sector of Wires,
Total
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No. s
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
.. No.of Luminaires SwimmingPool Above ❑ In- ❑ No.oef 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
jJ 's- No.of Ranges No.of Air Cond. TonsTotas No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals:_ Detection/Alerting Devices
Municipal
.-Noll of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other
i of Dryers
Heating Appliances KW Security Systems:*
°�INo.of Devices or Equivalent
> 1 c ,,No.of Water No.of No.of
e KVy Data Wiring:
I `�{ Heaters Signs Ballasts No.of Devices or Equivalent
l ."'+" �, IottHydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:,
„ ` No.of Devices or Equivalent
! ? )� l l i .ER:
J m. i L I Attach additional detail if desired,or as required by the Inspector of Wires.
( stinlated Value of Electrical Work: (Whenrequired bymunicipal policy)
, reir.r�..,. p po Y)
Woil$to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
"`- - INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuin office.
CHECK ONE: INSURANCE BOND a OTHER a (Specify:) J)D't,/iihq d- 0'/e.4I
I certify,under the pains and enalties of perjury,that the information on this application ' true nd complete.
FIRM NAME: &VS•de. El e&f ri•cal CQnied9 . 0.: A4171417
Licensee: ,b Signat O.:
(If applicable,enter"exei..
t"in the icense Y� ,) us. el.No.:.��77/-7270
Address: 37 &rsrl t.O i t. N-C1 It yen h iS,m A da(o 0/ Alt.TeL No.:S -goy 023t
*Per M.G.L.c. 147,s. -61,security work requires Department of ublic Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 50.00
.'.
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