HomeMy WebLinkAboutBlde-21-006501 -�.....►._ Commonwealth of Official Use Only
ifE Massachusetts Permit No. BLDE-21-006501
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:5/10/2021
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) 8 MOHEGAN LN
Owner or Tenant CASS WILLIAM E LIFE EST Telephone No.
Owner's Address CASS PATRICIA A, 8 MOHEGAN LN,YARMOUTH PORT, MA 02675-2445
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: Split A/C system
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. 1 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 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 Signs 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: Paul M Ryder
Licensee: Paul M Ryder Signature LIC.NO.: 39762
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:210 WESTWIND CIR, OSTERVILLE MA 026551366 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: $50.00
Ckl, A(k tv rr,
t,on onwis _`MassacItuddis Official Use Only n
�� (
'l �epartnE o/.fin JirvicRt Permit No. (h ' �(J
_�
I j ,' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYP ALL INFORMATION) Date: 1 7
City or Town of: A.i'/+^ 14 Ti.. To the ns ctor Wires:
By this application the undersigned ves notice of his or her intention to perform the electrical work described below.
Location(Street&Number) Q �j to 4,t,�a,,.. /a..NA ( ii0 .-/-
Owner or Tenant �i.// C d JJ Telephone Nara$) fit 7 -
Owner's Address ._14w..a. J-141Y
Is this permit in conjunction with a building permit? Yes ❑ No 12] (Check Appropriate Box)
Purpose of Building /.c,,f:.(,...c...t. Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters I
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity .
Location and Nature of Proposed Electrical Work: IA,)t re„ G--s..•1$J C. . A..— , �, , Jr,I
Ps✓1 tA- / .,I. /(1 t ,<> 6-- , 4- ./1-d Completion of the followin&table may be waived by the Inspector of Wires.
N of
No.of Recessed Luminaires No.of CeiL-Sus P•(Paddle)FansTransTotal
TTrsformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimmin Pool Above ❑ In- ❑ No.of Emergency Lighting
g arnd. grad. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of
No.of Switches No.of Gas Burners No. InDete and
Initiatinnggon Devices
No.of Ranges No.of Air Cond. ) Totals I No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
1 Totals: Detection/AlertingDevices
Municipal
No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other
No.of Dryers Heating Appliances KW N Securityy
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 No.of Motors Total HI' TelecommunicationsNofDevices
or Wiring:
Na of Devices or Equivalent
OTHER:
,o, Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: Ya V (When required by municipal policy.)
Work to Starts f-• 2- 2.1 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 issuing office.
CHECK ONE: INSURANCE tgr BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of pedury,tkat he information on this application is true and complete
FIRM NAME: ,/t € 11, ..../ �/tv/ A iev�- LIC.NO.:
Licensee: ',,iv/ A .,.r Signature LIC.NO.•
(If applicabl ,enter "exempt' in the license number line.), Bus.TeL Nq.�•/..24 -, al.Address: A c . f6vo4- //1. / 0J1 c-v1 �/s. Alt.TeL NV "
*Per M.G.I/'c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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)❑owner El owner's agent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE: $
p
•
•
..� ! , t pa',. ,d 4
t •0 n 411 .• a • • . ' . .