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Home My WebLink AboutBLDE-21-005358 Commonwealth of Official Use Only ESE Massachusetts Permit No. BLDE-21-005358 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:3/18/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 19 LAVENDER LN Owner or Tenant COX DAVID RICHARD TR Telephone No. Owner's Address THE DAVID COX REVOCABLE TRUST, 19 LAVENDER LN,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: Misc.work per attached. 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- o 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertinc 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: Walter W Kelly Licensee: Walter W Kelly Signature LIC.NO.: 21302 (I/applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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: $75.00 '41 /- 3&‘977-1dz ice- Vetv2- t ft-e 41 c 0(,1-1 ,N 41e �, ocJ 0 LA), -L.e?-9 - t- 50 -gige Ad—rd-Sr rromnnormaailrz o/f f aieac OMcia}Use Only r a �.: PermitNo. - 2—f — 5 .5`8 . ..Denim mer.t o� Services t; ' _ - Oc canancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS i • . I/07) peke blank APPLICATION FOR PERM T TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusers Electrical Code(ME 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO19 Date: 3 ii /DMZ-/ City or Town of: YARMOUTH To the Inspe for wires_ By this apulication the Imdetsigned gives notice of his or her intention to perform the electrical work desabed below. Location(Street&Number) 1? 4/3 I/406.w rt L.A./ Owner or Tenant Ar.1-4 t C X Telephone No...5311f Owner's Address S'14-A4 . ii-6 48'+n'Z-5:41 Is this permit in conjunction with a building permit? YefiZ„ NI).Q (Check Appropriate Box) Purpose of Budding Utility Authorization No. Existing Service Amps I Volts Overhead 0 Undgrd Q No.of Meters New Service Amps / Volts Overhead 0 Undgrd 0 Ni.of Meters Number of Feeders and Ampacity 'ST a i`L -,v1 t _- viOc",'` ,, Location and Nature of Proposed Electrical Work 0. 1 'f`_.... & ' li_ /— 3CD i r* -/3..c ci G.i m A P1-13( cote-01T ort_ FU iJ(u us-e2- 3itvAt r-c : a7 -1 askl1 k .. le' tb' AV t.J %-43 t. A\{ - • CC„mletion oftbe fallowing table may es waived by the hnoelor of Wires. j No.of Recessed Luminaires (No.of CAL-Susu.(Paddle)Fans 1No.of Toil ,,, � T'ransf'ot.�ers ICVA (.1- No.ofLuminaire' Outlets f No.of Hot Tubs (Generators ti-t, t Above In- l+to.0i Jrftergeacp>�ntmg a �. No.of Luminaires i5�viinmiag Paol mad.. _mitt_ L1 !Battery Units rrfOd' 'c.`' No.of Receptacle Outlets - No.of 011 Burners IFIREALARMS (No.of Zones No.of Switches iNo.of Gas Burners eti _. . (No.of Detection and { Initiating Devices I--COO No.of Ranges (No.of Air Cond. Total Tons (No.of Alerting Devices( - No.of Waste Disposers 'Heat Pump I Number Tons [KCW No.of Self-Contained I Totals:I I Detection/Aiex-1mo Devices `,% No.of Dishwashers - (Space/Area Heating I{W- Local Q uaiexpal 0 Other CoreaectSan No.of Dryers (Heating Appliances KW Security ity Systems:e No.of Devices or Equivalent No.of Water Ido_of No.of Heaters KW i- Data Wiring: Signs Ballasts No.of Devices or Equivalent I Telecommunications Wiring: No.Hydromassage Bathtubs (No.of Motors Total HP No.of Devices or Equivalent .I O111i.R - Attach additional derail tfdesiret(or as required by the Inspector of Wires. 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 COVERAGE: Unless waived by the owner,no permit for the pertbrtnance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation'coverage or its substantial equivalent The undersigned ce:rtifie s that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE . BOND Q OTHER Q (Specify:) I certify,render die pains and penalties ofperJm75 that the hArnEcttion on this appffeation is true and complete. qjFIRM NAME: '\Ct.1,LJ�r [ E; 0 t_, �r�rt i nt} �uC f IC.NO.: (/ C)49 4 Licensee: 1,30:.t-1-- ..r id.:Q11;� gnat ure f,t 1 t�Q Il f��•— LIC NO.: / /p 3 (Ifopplicable.enter"esempt"in the licerr1e number line) Bets.TeL No Address: J f'' ';f '-° I t 1 •CT .9 r li�' lu 4 7'k 09— Alt Tet No.:. p -9 j *Per M G_L,C. 14 ,s_57-61,security work requires beparoiient of Public Safety"5"License: Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 5 required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent Owner/Agent1 II Sfernaiure Totonhnna Nn - PERI�IF� FEE: T r ,111.