HomeMy WebLinkAboutBLDE-21-007561 -
Commonwealth of Official Use Only
E ►�_ Massachusetts Permit No. BLDE-21-007561
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:6/29/2021 _
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) 18 CARVER RD
Owner or Tenant Jackie Lodge Telephone No.
Owner's Address 18 CARVER RD,WEST YARMOUTH, MA 02673
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: Basement receptacles for ice maker&water heater.
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/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 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:$50.00
(1& 9115 f24
r ... Commerswra�O1 rrlaeearkiwaed'e Official Use only
,: s-�� Permit No. —7S (
\1/4:;.i., `« tyear+tN►etd a/..rw.e Sert�cN
Occupancy and Fee Checked
BOARD OR FIRE PREVENTION REGULATIONS Rev. i/07) la
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be prtbrmed in accordance with the Massachusetts Electrical Code(M13C), 27 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL FORMATION) Date: 02(i oZ I
City or Town of Cc,{t' c o ( f'( To the Inspect of ill s:
By this application the undersigned gives of Ms or Intention to the electrical work described below,
Location(Strict•Number) (,a V 64G----
Owner or Tenant Telephoto No4(3- gs!S 70 6 6
Owner's Address
Is this panto in co jeactloa with a building permit? Yes 0 No 16. (Cheek Appropriate Box)
Purpose of Bening Utility Aotharlaatlon No.
Existing Service Amps / Volta Overhead 0 Uadgrd 0 No.of Meters
Nizijaha ,......... Amps ( Volts Overhead 0 Undgrd 0 No.of Meters
Number of Peodoro and Ampeclty 1 /
ion and Natal* p Elee$rIcel Work: d .e 0 cc ' T
vn 'ki-t a/ l - -e I%—
Comckdon oilbtil/bYlffajgh.Vrw be waived by Ors .:4, , of Wks,.
No.of 1Merssed Laraitadrw No.of Cali.-rl sp.(Paddle)Fans Ili.or
1 .
No.of Laminaihe Outlets No.of Hot Tabs Gmserators KVA
Above 'Ia. .� � nns
Na.of Ltatbaisw Siwita drool osst O__ttad..
No.of Receptacle Outlets No.of Oil Burners IRE ALARMS 1No.of Zones
Na.of Switches Na of Gas BorersNei d
No.of Ranges No.of Air Cond. PIS
RI Na of Alortiag Device
No.of Dishwashers Spaco/Area Rooting KW Loeat 0 ` �', 0 Other
No.of Dryers Reeds'Appllanas KW ,, + .,, of licttriv dent
Ro.of W ice K Wv 'No,or zit Data ' 1
No.Nydramassage Bathtubs No.of Motors Total RP l'o.. -, ,.... 9C ,., .4 s , t
OTNERt
kWh millstones!atoll Poirot(or as wgaiwd by rs)tt inspector of*trot
Estimated Value of El •.foal Work: �o rah • (When required by municipal policy.)
Work to Start: ( I • .. . /o be requested in mordant*with MEC Ruls 10,and upon completion.
INSURANC . -ri ,w TTr''r :r mess waived by tiro comer,no wash fbr the perlbrtnttnctr of*Wiriest work may imue unless
the licensee provides proof of liability insurance including"completed operation"coverage or Its substenthI equivalent. The
undersigned oertifes that such coversge Is In force,and has exhibited proof of same to the vomit issuing else.
CHECK OM INSURANCE Ca BOND 0 OTHER 0 (Specie:)
I eery,ostler Me pains end pawl*.ifperjtrry,that elm IRfore vdon on this*phoebe Is ache toed cemplMa
F'IRMNAMEt Cane Cod Electrical LIC.NO.: 21Aa,2.A
Limnos lit cis MoUrgy Sigeettore drIC,NO.� �
yle,enter"extow le hams member 11nej Sw.Tel Not
AAddressrP, Bgx) S94 .J!gfeigni MillsMilIs)tA 0ZQ4k Alt.TaLNo.:
*Pet M.O.L.o,147,s.J9.61,security wait multi'Department of Public Saafety"S"License: Lie,No.
OWNER'S INSURANCE WALVERt 1 ant aware that the Licensee doss not have the liability Insurance coversp normally
wi�by law. By my signature blow,1 hereby waive this requirement. I am the( ) 0 , ',
Sign r Agent Telephone No. PE RIM" ' $ , 0,aJ
8lgaatttn � .- p
Email: Offleesapecodeleetriclaa.cotu