HomeMy WebLinkAboutBLDE-22-001730 #250 04* Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-001730
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:9/27/2021
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) 237 NORTH MAIN ST
Owner or Tenant DAVENPORT DEWITT TR Telephone No.
Owner's Address DAVENPORT REALTY TRUST, 20 NORTH MAIN ST,SOUTH YARMOUTH, MA 02664-3150
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: Renovations k [a
Completion of the following t,.le., - r nspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of �/Total
Trans ••, rs �o) 46 VA
No.of Luminaire Outlets No.of Hot Tubs GeneratoA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergen O
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.o
No.of Switches No.of Gas Burners No.of Detection and D
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/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 Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Eauivalent
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: LANCE A MACENERNEY
Licensee: Lance A Macenerney Signature LIC.NO.: 11149
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 126A MID TECH DR,W YARMOUTH MA 026732560 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: $80.00
Commonwea[pt o/V104,144 1444116 �Official Use Only q 2
�' ;: = 'r cc�� cc77Permit No. 1:. 7/Z 1 i J 0
ern; 2).partinent oIra�orvicae
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Y" Occupancy and Fee Checked
1/41/4.
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: q L31.
0 City or Town of: \10(nt\O tAK 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&Num� 1 ► 1C Number) ?3 7 K, i ' S.+, ' n 1 + a50
Owner or Tenant—1- i r,4O6d P 'Gkte, Telephone No.
AJ
el
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
-75
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
vNew Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
e ' Number of Feeders and Ampadty
® Location and Nature of Proposed Electrical Work: g e_h n A.4-'t O n �S ' Q t Yl c�-
V Completion of thefollowingtable may be waived by the Inspector of Wires.
LID No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans Tof 'Dotal
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ Ba of emergency Lighting
grad. grad. Battery Units
No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners "No.Initiatinnggon Deteand
Devices
Ili No.of Ranges No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: ��" Detection/Alertint )evices
No.of Dishwashers Space/Area Heating KW Local 0 MonneunidMp ion ❑ oto
C
No.of Dryers Heating Appliances KW Securitys:*
Na of Die s or Equivalent
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or ' 'uivalent
No.Hydromassage Bathtubs No.of Motors Total HP Teleco of Deunivicesces o
of
No. Deorns W
Egaiv nt
OTHER:
Attach additional detail rf desired,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 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of palmy,that/no--the information on this application is true and complete.
FIRM NAME: Rd ter p 11.L r%C w MQ(l' LIC.NO.: f A I 1�'1
Licensee: 14(\e-e... wad, En erne./ Signature �� LIC.NO.:
(If applicable,enter"exempt"in the lice a numbe line.) Bus.Tel.No.: SOS- `77c- OO 30
Address: Ialplq M c d Ter...V\ Dr Vi. tl(t'1'1Qu+k Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: 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)p owner 0 owner's agent.
Owner/Agent
Signature Telephone No. (PERMIT FEE:$ $0.00