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HomeMy WebLinkAboutBLDE-22-003557 Commonwealth of Official Use Only : '� Massachusetts Permit No. BLDE-22-003557 Ir,7 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) City or Town of: YARMOUTH Date:the Inspector/27/2021 By this application the undersigned gives notice of his or her intention to perform the electrical work d sc ibed below. of Wires: 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? Purpose of Building Yes 0 No CI (C ) Existing Service 100 Amps Volts Utility Authorization 1* a w Overhead 0 Undgrd 0 ,`m'rs New Serviceg _, 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. 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 Transformers Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool g boved. ❑ gIrnd ❑ No.of Emergency Lighting rn Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiating Devices No.of Air Cond. Total Ton No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: No.of Dryers Connection Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent KHeaters Signs No.of Ballasts Data Wiring: y No.of No.Hydromassage Bathtubs No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) 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 I certify,under the pains andpenalties o (Specify:) fperjury,that the information on this application is true and complete. FIRM NAME: WALTER W KELLY Licensee: Walter W Kelly (If applicable,enter"exempt"in the license number line.) Signature Tel. NO.: 21302 Address:7 MONROE LN,WEST YARMOUTH MA 026732731 Bus.Tel.No.: 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. Signature Telephone No. C PERMIT FEE:$50.00 ' '',. 044 1 1)14 C CO 0"Q d A S L C tC11-* _ Commoncvaaatl.of Maaaachaasfts Official Use Only } ar - 7 �' cc77� {{s� Permit No. �2`2---3 SJ' S # ti . r rtawni o/.y`ir+s&rvice4 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked qi "' [Rev.1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .. All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 MR 1 .00 " --,.I (PLEASE PRINT IN INK OR TY INFORMATION) Date: /� (3 ��) 3 City or Town of: MO U T To the Insect o 'I�, By this application the undersign gi es notice of his or h intention to P f k described Location(Street& , ter) 4 1J._NP/worm the electrical work cn below. Owner or Tenant ,r° ___� ©"C._ Telephone No. 5!� Owner's Address 94A4....1 •' ��-2-�-Z Is this permit hi conjunction with a building permit? Yes 0 No f Purpose of Building (Check Appropriate Box) AmpsUtility Authorization No.733 ExistingService 0� /dO/ al*Volts Overhead. Undgrd 7C-6( �-' New Service g ❑ No.of Mete Amps / /, Volts Overhead Undgrd 0 No.of Meters _/ Number of Feeders and Ampacity T-- Location an,,Nature of Proposed Electrical Work: /0 0 /9/1iP 0(467~ C er01� 2 No.of Remised Luminaires Completion of thefollowingtable may be waived by the 1 torof Wires. No.of Celt.-Snap.(Paddle)Fans No.of t Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In.. No.of Emergency Lighting No.of Receptacle Outlets grad. mod' ❑ Battery Units No.of oil Burners FIRE ALARMS }No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and No.of Ra Initiating Devices No.of Air Cond. Total No.of Alerting Devices )[ors Heat Pump Number Tonnsons ITV No.of Waste No.t of Self-Contained No.of Dishwashers Totals: __. _._� _ .____ Detection/Alert's'Devices Space/Area Heating KW Local❑ Municipal onnection 0 OtherNo.of Dryers HeatingC Appliances KW Security Systems:* `o.o "ater No.of Devices or E t uivaient Heaters KW o•o o.o` S'1 s Ballasts Data Wiring. No.Hydromassage Bathtubs No.of Devices or uivalent No.of Motors Total HP : ' ' m , :: , "1, : OTHER: No.of Devices or i ulv nt Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) Inspections 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 undersigned certifies that such coverage is in force,and has exhibited proofof samec to theee or its substantialssuif equivalent The CHECK ONE: INSURANCE X BOND 0 OTHER of to permit issuing office. I certi ,under the0 (Specify:) FIRM NAME: and � of ', the information(t►i this a lication is true and complete / Licensee: LIC.NO.: /3 19 Lfappticable,enter`Ere Signature ►� C,(--, LIC.NO.: J 3'�/1�"' Address: "Exempt" a license member line. ' us.TeL No.. *Per M.G.L.c. 147,s.57-61,security work requiresct Tel.No.: � � License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware tha t Departmenticensee does noSat have the liability insurance coverage normal required by law. By my signature below,I hereby waive this e Owner/Agent requirement. I am the(check one • owner •owner's:, Signature _eat. Telephone No. PERMIT FEE:$ , i