HomeMy WebLinkAboutBlde-21-002629 Commonwealth of Official Use Only
Of Massachusetts Permit No. BLDE-21-002629
11:111BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.l/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:11/10/2020
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) 21 RIDGEWOOD DR
Owner or Tenant FREEHLING JOSEPH M Telephone No.
Owner's Address C/O stk-PATRICIATE,21 RIDGEWOOD DR,YARMOUTH PORT, MA 02675
Is this permit in conjunction with a Ibdllditig permit? Yes ❑ 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: Replacement boiler.
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 1 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/Alerting 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 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:
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
A- 3 (1 ( (zi
CVA(9 02421 c
-1• C,enMnornRli e{/►/�ueac�iweeite Official the Only
I. r 't �` Permit No. " �2q
2pe. rtwit°l gin SIMAiCI!
} Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev,
. ,, C 1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be pertbnmed In accordance with the Massachusetts Electrical Code .527 CMR 12.00
(PLEASE PRINT IN INK OR TYP ALL INFORM! 1 N) Dote: I( 6 (ao
City or Town of: , GLtD (i To the Inspe for of Wires;
By this application the tinders' Ives noticei or her ntention to perform the electrical work described below.
Location(Street£Number) 4-( drr. (,O OCO b e.
Owner or Tenant P4.1"- E°cey/ Telephoto No.50 r .3(7.S5 ZS
Owner's Address J
1e this permit In conjunction with a building permit? Yes 0 No W (Check Appropriate Box)
Purpose of Building Utility Authorisation isatien No.
Existing Service Amps / Volts Overhead 0 Urdged El Na of Meters
&LW* __ Amps / Volts Ovesitead 0 Uadgrd 0 No.of Meters
Number of Feeders and Ampadty
Location and Nature of Proposed Electrical Works VUt it.,Q ,o c [ L.
Co Manor ttr_.1bLlowkm Na mfa o be wathvd,¢y the Ivor efwtrw.
No.of Recessed Luminaires No.of Celli-Sup.(Piddle)Fars 'Dadaism 1i'�t�ybbA
No.of Lnaalraire Outlets No.of Hot Tube Generators KVA
Above Ia. Ai rg�y snag
Na of Lussalrairt swimming Pool � 0 ❑ Ida
No.of Receptacle Outlets No.of 00 Burners FIE ALARMS No.of Zones
No.of Switches No.of Gas Bursar No.liZergotres
Totsf
No.of Ranges No.of Air Cond. UN No.of Alertly*Devices
No.of Waste Disposers ki. 1lIS �.. � ,.. `No.of "":f
No.of Dishwashers Space/Area Beating KW Loea l C] ,` ' 71 0 Other
Healing A bnea KW ^�
Na of Dryers i Pld • ' , Pr E.orivaleat ,
`Ra of�ater KW No.of Ito.or Data Wit t
Resters Ballasts t, ' o f ,r II . t
No.Hydrossasup Bathtubs No.of Motors Total HP :,, d'.*;' or
OTRERt
Attach Mrblkunal detail Vaal or as rmgalred by the Inspector rf li'b eye.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested In accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGEs Unless waived by the owner,no permit for the psrfbz mane of electrical work may issue unless
the licensee provides proof of liability insurance Including"completed operation"coverage or is substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of ume to the permit Issuing office.
CHECK ONE: INSURANCE (p BOND 0 OTHER 0 (Speottyo)
1 core,Nader the polio and pon Wa►of pods*,Ono the S*msasles on this application is O .and cooplad4
FIRMNAMEi Cane Cod Ejgptytosj LIC.NO.t 22642.A
Licensee* pi!c k McElroy Signature '--; -tf LIC.NO.: _
(Ifappllcab enter"exempt in the license nraaber lbw) Bus.Tel.Nai ta�:L4S9
Addressask.Q. Box 1594 pjgrsjona Milli MA 02648 Alt.TeLNo.r
*Per M.O.L.0. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie,No.
OWNER'S INSURANCE WAIVER: lam aware that the Licensee does not have the liability anew snce cover ge normally
required by law. By my signature below,I hereby waive this requirement. I am the( okw)Q 4• jj owner's soh,
Owner/
Aim PERMIT FEE $ O•cc)
Slgaaprr Telephone No.
Email: Olfice(Bcapeeodeiectrklan.com