HomeMy WebLinkAboutBlde-19-007197 co Commonwealth of Official Use Only
(fctt Massachusetts Permit No. BLDE-19-007197
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•6/24/2019
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 84 TROWBRIDGE PATH
Owner or Tenant BELL THOMAS J Telephone No.
Owner's Address BELL CAROL,223 BAY COLONY DR, JUNO BEACH, FL 33408
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: Ductless A/C
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. 1 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 ❑ 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 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: SCOTT D MORRIS
Licensee: Scott D Morris Signature LIC.NO.: 18338
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:PO BOX 1264, HARWICH MA 026456264 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
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Commonwealth of Massachusetts Official Only
_ ',_*=rysk_ 't Permit No. ✓ LJ
„'- , Department of Fire Services
1-11- " Occupancy and Fee Checked
_= BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07
4...v . (leave blank)
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: 06/19/19
City or Town of: West 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) 84 Trowbridge Path
Owner or Tenant Bell Telephone No
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Wiring for ductless AC.
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
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertin,g Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ other
Connection
No.of Dryers Heating Appliances KW Secs:*
urity
DevicesSyster or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications o Devices
or EquivWiringalent
g No.of Devices 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: 06/18/19 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 o.-- •tion"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited - oof•f same to the permit issu.•g office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Sp. ify:)
I certifi,, under the pains and penalties of perjury, that the informat on o . ''s application is a and complete.
FIRM NAME: SDM Electric,Inc. A / LIC.NO.: 18338A
Licensee: Scott D.Morris Signa• .1 _0111W,I,F1'410 /L� LIC.NO.:
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508 430 4014
Address: PO Box 1264 East Harwich MA 02645 Alt.Tel.No.: 774 353 6902
*Per M.G.L.c.147,s.57-61,security work require Departm; t of Public Safety"S"License: Email:scottmorris@sdmelectric.com
OWNER'S INSURANCE WAIVER: I am aware • e Licensee does not have the liability insurance coverage normally re-
quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
MO.