HomeMy WebLinkAboutBLDE-21-007043 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-007043
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:6/7/2021
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) 55 SULLIVAN RD
Owner or Tenant MEIMARIS JAMES Telephone No.
Owner's Address 33 DECATUR LN,WAYLAND, MA 01778
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: Install exterior 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 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
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 ❑ Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
1 No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs N of Mo rs Total HP Telecommunications Wiring:
t 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 re ui d by municipal policy.)
Work to start: I spection a requested' accorda ce wi MEC Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by tnseowner,no perm' o he perf e of electrical work may issue unless the licensee
provides proof of liability insurance including"completed operation' vera oYits substantial equivalent.The undersigned certifies that such
coverage is in force,and has exhibited proof of same to the permit iss ' 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:
Licensee: Nicholas McEloy Signature LIC.NO.: 22642
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:31 Captain Carleton Road, Cotuit Ma 02635 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: $50.00
COMM.M OIN At 41 ir/aaac�iwe.0 Official Use Only
Permit No._'--/I (y3
. .*."y «25e1.6..M!WA.,3.,.k.,
Ooaupsna)+
BOARD OF FIRE PREVENTION REGULATIONS ev, Iro7j end Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
WORK
AU work to be perlbrmed in aceorda ee with the Mwsohusnts Electrical Code(MEC),
(PLEASE PRINT IN INK OR TYPE A INFORMATION) Dates %J1d V/
City or Town of: fee(' 0 ht To the Inq,. for Wlros
By this application this undersigned notice of h or er Mention to perform the a wtrtosl work deeoribed below,
Location(Street A Nambsr) /It 1Ice 'h /fCL
Owner or Tenant rl S .c 1 4CC Yl LS Telopiioue No.So>ir•f`1`f b C C)
Owner's Address
II this permit is coojasottoa with a building psrmkt Vol 0 No 123 (Check Appropaiste Box)
Purpose of Building Utility Authorise**No.
Existing Service Amps / Volts Overhead 0 Uadptd❑ No.of Meters
Amps 4 Volts Overhead 0 Uadprd 0 No.of Meters ___..
Number•f herders and Asperity _
Location and Nature of Proposed tlastrMasl Work' a-11.5 12A_ fir t-Q,r icy' X i'y •/S.
thehbltowt�... waived to,the x..w�y,•� eft
No.of Rse�ssed Lsmisetrss Na of Cell-Stuff.!(P a4 o.o
No,of Lnal aatre Outlets No.of Hot Tubs OoMerabn
KVA
No.of Lumi�res Swinish*Pool ❑ tad. L . 1; . UAW
No.of Reoeptase Outlets No.of Oft Burners `��Fly �ALARMS INo.of Zones
No.of Sw itches No.of Gas Serum o' �" ''i ..,.I.,,
No.of Rees No.of Air Coed. T No.of Alerting Devices
Na of Waits Disposers .-_. 1+4O. '' ice+
No.of Disbw ekors Spaoe/Arm B..U.$ KW Losa1 CI ' ,......-' ❑Other
No.of Bryon Hades Applisues KW i Of
4 Lattivakrt
t4.orvictinv KW No.of gursts Deb W
MIR ....r. .1 y { y r
T
No.Hydroma. s Bathtubs No.of Motors Total 11P . '°'` qr 44:"
OTU Rs
Attach a ilttoeea1 detail(fdau or as'required by the Decree ae.
Estimated Value of B earl i Work: oZ'-q, -�`' (When inquired by municipal policy.)
Woak to Start: to z.. Inspections to be requested in accordions with MEC Rule 10,and upon completion.
INSURANCE OEt nloss waived by the owner,no permit for the perfbrmanos of electrical work may issue Weis
the lioenseeprovides proof of liability Inman**Including"completed operation"coverage or Its substantial equivalent
The
undersigned codifies that such oowrega is in fbros,and has exhibited proof of same to the Perm*Isar office.
CHECK ONE: INSURANCE ® BOND 0 OTHER 0 (Sf)
I carry,Mader ttttvpsthrs mMpasalfast ep*'paP"? that the St4Plemilon ON Meth Arplicetioa is Imo alai warms
FIRMNAMBt Can: Ca4 <iuloe1 _ LIC.Nat 22�s2.A
Llesseset i q k o r g y Syatur'e �,�-�''' LIC.NO.t
(rapy►kable,vier"snow"in the ftwnx mother line] One,Tel.NoalaitatE
A:ddrwstp.Q. Box. 1_511.14,.1K!,iQOs Mills MA 026411 AN.Tel,No.: -
•Per M.O.L.a. 147,s.5741,mouthy r worts requires Department of Public Silky"8"Limnos: Lao.No.
OWNER'S INSURANCE WAIVERt I am swam that the Liman does hat hew the liability insurance°overly normally
requlnai},by owty. By my sign below,I hereby waive this requirement. I am the(As,ono)Q r 'o.t.,
Slgaaturo Telephone No. I M1t M 11171:$ .,r'a.w
Esneih Ontao®eaperodeleatrieitar.eom