HomeMy WebLinkAboutBLDE-21-007088 0 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-007088
`%- 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 perto etec 1 work describ below.
Location(Street&Number) 72 TANGLEWOOD DR ; ( �], iQZO
Owner or Tenant G Telephone No. /% —)---''178— 65 2-
Owner's Address --:... - —• _ a _ _ A -- . - -4:,?_....',,�.���._.:. .•
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 recessed lighting in hallway.
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 0 In- ElNo.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
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 ❑ 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 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:
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
y \3„ , z3
(7,2v
Permit No. 6E24--- i7Oese
w lopsoimedst e AmJr'.wk..
'► Oocupanoy and Pee Chocked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) lei _
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ail work w be premed in scoordanoe with the Mssssdnusetts Electrical Code ,$27 12,00
(PLEASE PRINT 1N INK OR TYPE AL INFORMATION) Date: e. t7 02-
City or Town of �0 (17 To the Imps for o Wires
By this appliation the undersigned gives a o1rhis or lee on roes to the et t work described below.
London Minot al!Number) 7o fe (A) oa�cc 1)v
Owaor or Toast k J#I C ( row 0 ( " Teloplore No. 4//3. VS'.q, "
Owner'Address .,
R ibis permit is cosaaclios with a bondkag penult? Vile 0 No ( (Check Appropriate Sox)
Purpose of Building UtWty Autborixatloe No.
LxMNy Service Amps / Volta Overhead 0 Usdgrd 0 No.of Meters
N. .... ,._ Amps { Volts Overhead 0 Uaadgrd 0 No.of Meters _�__„
Numbsr of Poodon and Ampaeity
Lingle'and Nature of Proposed RiosMai Work* .,3/A•-fa.GC 4C'SS ea Ki eth n hullw
Conan the be wawtb the -,, 44 • of frirw`
No.of Rmesmeed Lumianlwe No.of CelL4isp.(Md.)km Tom ,t A
No.of Loaarbralre Outlets No.of Nat Tub Gasoratots KVA
No.of L atoolras Swtm. Pool arnd. 0 Hut. 0 ,mac Utter _
No.of Receptacle Outlets Na.of Oil nursers FIRE ALARMS 1No.of Zook
No.of Switches r Ne.of Gas Serum moo.
- god
No.of iRaauge. No+of Air Cod. Na of Alsrnos Devises
No.of Waste Disposers ltil - 14a , 1t'"r°{"',4' ,
No.of Dbbwaabmn Spa /Arse Mathis KW Load ■ .rkw', ❑Other
No.of Dryer Reedas AppUaaomm KW r. t'1!"i .,... . otl'aady:tlont
Pro.ottWctm KW 'eta of tilts pMrt
No.Hydra matse.e tlatbtub No.of Motors Tots,RP T . `+, a i 4,4,.
OTHER*
o ,Utach atalutonal detail(rds or as rsyldwd by the inspector of Pkw.
Estimated Value of E oal Work: !lib " (� �by POW.)
Work to Stert: 6 1Inspection to be requested in a ccordanoe with MEC Rule 10►and upon completion.
INSURANCZ Ss Unless waived by the owner,no permit list the pit ter sno.of eleotriwl work may Issue unless
tho undersigned cep tanas Ms thata proof of �overrage i and has►o�prro�same permit i equivalent. The
CHECK ONE: INSURANCE II BOND 0 OTHER 0 (spsle':)
I cmafy ,seder M.poles one Ipooh*ey'pornrry.t Om tttpr+os dOA on short gploaket to awe end coreprtewr.
iPIRMNAME: Car. cog JL4gs11c111 :i: _ LIC.NO.: 22h0.A
Liosaaruet i o k M o$tr o Sigsattas a ,mac%e LIC,NO.t
(ropplkok i,tear"moor In r home nwnbr 11)10 DU Tel.Na
Addraiisr.Pt Box)494 Mkrgtona Milli MA 0264.E Alt.T.i.No.,
*Pm M.O.L M.O.L.o. 147,a.3741,security work requires Dep.rbrent of Public Satbty"8"Luke: Lim.No.
OWNER'S INSURANCE WAWERs I am swan that the Llama's*door not how the liability insoronos coverage normally
a u r by tactw. By my signature below,I hereby waive this requirement. I am the(dog oaf 0 rig p owner)ai .
Sypatun Telopboa.No. Pinarru:s -0,
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