HomeMy WebLinkAboutBLDE-20-001087 Commonwealth of Official Use Only
" Massachusetts Permit No. BLDE-20-001087
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:8/27/2019
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) 1180 ROUTE 28
Owner or Tenant GOODE JAMES R TRS Telephone No.
Owner's Address GOODE KAREN E, PO BOX 670, EAST DENNIS, MA 02641-0670
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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Relocate sign lights.
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 2 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grad. 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
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: EDWARD L MERRY
Licensee: Edward L Merry Signature LIC.NO.: 17137
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 15 CHECKERBERRY LN,W YARMOUTH MA 026733636 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: $80.00
- Commonwealth of Massachu- �Officci�iaal,�Use Only
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lei ` f/ setts Permit No. C.2!) -
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as - Department of Fire Services
n'" ` '' p Occupancy and Fee Checked
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ii (,D i "� �'/' BOARD OF FIRE PREVENTION IRev. 1/07] (leave blank)
i' REGULATIONS
G N A FPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
I � ,0 !! All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
WLE PRINT IN INK OR TYPE ALL INFORMATION) Date: 8-27-2019
0
I ! Qity or Town of Yarmouth To the Inspector of Wires:
TRy ltcatton the undersigned gives notice of his or her intention to perform the electrical work described below.
-- "LoclttlBB'(3treet&Number) 1180 MA-28,South Yarmouth
Owner or Tenant Cape Cod Brass Jim Goode Telephone No. 508-394-2300
wner's Address
—F.I Is this permit in conjunction with a building permit? Yes 0 No *❑ (Check Appropriate Box)
''',„.„e Purpose of Building Retail Utility Authorization No.
v 0 gExisting Service 600? Amps 120/208 Volts Overhead ElUndgrd ElNo.of Meters 1
New Service Amps Volts Overhead❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Remove ground lights at sign and install wiring and sign lights at top.
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 ICVA
No.of Lighting Outlets No.of Hot Tubs Generators ICVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grad. grad. 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. TO�I 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 ❑ other
Connection
No.of Dryers Heating Appliances KVy Security Systems:
No.of Devices or Equivalent
• No.of Water KW No.of No.of Data Wiring:
Hydro
sSigns
No.ofBallasts No.of Devices or Equivalent
No. ro massage Bathtubs Motors Total HP Telecommunications Wiring:
a No.of Devices or Equivalent
i OTHER:
G Estimated Value of Electrical Work: (WhenAttach additional detail if desired or as required by the Inspector of Wires.
required by municipal policy.)
QC? Work to Start: 8-27-2019 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
Ill proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in
SM force,and has exhibited proof of same to the permit issuing office.
`\ CHECK ONE: INSURANCE ® BOND ElOTHER El (Specify:) GENERAL COMP.LIABILITY 06/24/2020
o► (Expiration Date)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Ed Merry Master Electrician Inc. LIC.NO.:A17137
S Licensee: Ed Merry Signature E.141hi/ LIC.NO.: 35745E
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508-221-4335
Address: 15 Checkerberry lane West Yarmouth.Ma.02673 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"L. se:here: Lie.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. I am the(check one)0 owner ❑owner's agent.
Owner/Agent PERMIT FEE:S
Signature Telephone No.
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