HomeMy WebLinkAboutBLDE-22-006050 Commonwealth of Official Use Only
is A_ Massachusetts Permit No. BLDE-22-006050
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:4/21/2022
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) 32 SHORE RD
Owner or Tenant Michael McChesney Telephone No.
Owner's Address 32 SHORE 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: Septic pump&alarm
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 ❑ n- ❑ 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 1
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
Ny.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 1 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: PAYZANT ELECTRICAL CONTRACTORS
Licensee: Kevin Mott Signature LIC.NO.: 22677
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 118 Long Pond, South Yarmouth MA 02664 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 my
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
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"1'.:'t''... ,iNGUE FA i G Commonweah of Maeaaclueife
Official Use Only
Permit No. €11 lDOUsvartmsnf oI,}irs Serviced trte. p
By '' 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 TYPE ALL INFORMATION) Date: ! — 2 Q _2
afze
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) 5 a , rE R b
Owner or Tenant rn i v1= plc(i-t h )Ey Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters
New Service Amps / Volts Overhead❑ Und rd
g ❑ No.of Meters
Number of Feeders and Ampacity
1 Location and Nature of Proposed Electrical Work: ' --ç .- "TT:30‘.3 I N c4
,
kt1
fv Completion of thefollowingtable may be waived by the Invector of Wires.
�! No.of Recessed Luminaires No.of Cell.-Susp. No.of Total
n! p (Paddle)Fans Transformers KVA
�=,1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
grnd. grnd. 0 Battery Units
No.of Receptacle Outlets No.of Oil Burners
FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners ''No.of Detection and
1 Tonsal Initiating Devices
No.of Ranges No.of Air Cond. ToNo.of Alerting Devices
No.of Waste Disposers Heat Pump Imb
Nuer[Tons {KW No.of Self-Contained
Totals: 1. Detection/Alertinl�Devices
No.of Dishwashers Space/Area Heating KW Local 0
Municipal
Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters ' No.of Data WIring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
t7.71�ZZ (When required by municipal policy.)
Work to Start: q-Z
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no pennit 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: INSU' i. CE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the p ns and penaltio pm* ,that the information on this application is true and complete.
FIRM NAM : !�'� A AU%/ n
. ' = •-I 6 /L LIC.N0.• �i7 LZ(Q77
Licensee: t _l C
Jl (���— Signature
(If applicable,enter"exempt"in the license number line.) �`Z LIC.NO.: LAC- ZZ� 7�
Address: Bus.Tel.No.• O „y36_7
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: AIL 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 ■ owner's a:ent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$