HomeMy WebLinkAboutBLDE-22-001386 Commonwealth of Official Use Only
Massachusetts
Permit No. BLDE-22-001386
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:9/10/2021
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) 7 DUPONT AVE
Owner or Tenant Mike Mahoney Telephone No.
Owner's Address SOUTH YARMOUTH, MA 02664-1203
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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Split A/C(Two heads)
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- ❑ 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. 1 Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons _ KW No.of Self-Contained
Totals: Detection/Alerting 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 Eauivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Eauivalent
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: Jeffrey T Foss
Licensee: Jeffrey T Foss Signature LIC.NO.: 36938
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:33 SULLIVAN RD,W YARMOUTH MA 026733543 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
ekkC9t- ?/144
�;�-` i r�,1 !; _. � rnd,{,i,._7..,aice:t Permit No. � I
t _ ,
1��0 1. > BOARD OF FIRE PREVENTION REGULATIONSO°��and FeeChxked
UV] _ bbl
APPLICATION FOR:PERMIT TO PERFORM ELECTRIC
��mbe in the �,M. WORK
(PLEASE PRI. T flit INK OR TYPE IIeate: Code(MEC), I>M.
ALL 0NI Date:
City or Town of: lA To the l
By this application the undersigned gives Lice of his or her' _ nspedo ofa •>
„,./�tioa to • the � tf below.
. Location(Street&Number•) ii/ ' /a i �) e r C riche
•
Owner orTenaat L( ,�/�Ii �ym �g
Owner's Address L: ,,./ rl /� 1,. Telephone No. j,� ;�'/> -,0�0
Is this permit in caaitraction with a
Purpose of g P nrt? Yes ❑ Ato
(Check
B�� Appropr�Bar)
Utility Authorization No.
Existing Service DQ s / ()Volts Overhead
ew Service Uat�at•d❑ Na.of Meters
Amps / Vohs Overhead❑ Undgrd 0 No.of Meters
Number of Feeds and Ampacity
Location and N of Proposed W ,,
L I %Iw L /e of orm /�� .��� ,���/
No.of Recessed I, Completion o the To • i table• - be waived; the . Frees.
No.of Cel.-Busy,(Paddle)gens o.o
No,of Luminaire' Outlets Transformers KVA
No.of Het Tufts Generators KV4
- NaafLami ,Swig gPooi in-�� ❑ g'nor
�� 0 izr,[Tiffs No.of Receptacle Ordets No.of Oil Burners
FIRE ALARMS No.of Zones
No.of Switches
No.of Gas Burners o-o o'•_..,Devices< and
No.of Raugss `. - "" 4
No.of Air Cond. o
No.of Waste , _ Tom No.of Devices
Disposers
mP ati!�??lToes .. `0.0 , on.
No.of Dishwashers Totals: , oa/Aler[i1w Devices
SpacelArea Heating KW- Local❑ stnectat
No.of Dryers Heating Appliances KW Cpnaeta
o.of Heavers KW o-o o.of No.of a '- or t
Suns Ballasts beta Wiring;
No.Hydromassage Bathtubs Na of Devices or t
No.of Motors Total HP ecommanications;firing:
OTHER No.of Devices or .•uivalent
Value of 1-�, .•�— Attach additional detail ifdesired oras reguirmi by the Inspector of Fres
Wor)i
. Estimated Work to Start /� ��required by municipal policy.)
INSURANCE `T Inspections to be requested in accordance with MEC Rule 10,and
upon completion.
.� GE: Unless waived by the owner,no permit for the performance of electrical
the licensee provides proof of liability insurance including"completedwork 'issue unless
undersigned comes that such coverage is in force, operation"coverage or substantial equivalent. The
CHECK ONE: INSURANCE • g and has exhibited proof of same to the
'2-1
�^ CE �.t BOND ❑ OAR ^ permit issnin ofce.
\ I c�Y,under the pains and.. , of pm! thm 0 (Specify:) his p i true
and oft. �d/
PERM NAME; :try, the information on this aPP n fs true and coarfrLete Z
€ censee: al�L - LIC.NO.:
i itIN Signature � LIC.NO.: y rte4 ,_`
(t .,'1,/,'
. •girlie •
Address: f� r /i I i / : �, Bus.TeL No- .�
requires ,1,� .,,i ClyGy
• J 'Per Address:
. I s.57-61,securitywork .. •• Ait.Tei.No.: Wit♦////,.
.� OWNER'S INSURANCE WAIVER: 1 am DeparGnea of Public�- "5"Li-�.-, , Lie.No.
.. requiredmaw. By my signature below,I h aware that the Licensee doer not have the liability insurance coverage
hereby waive this r quirement lam the(check one 0owner normally
l Signature. owner's
Telephone No. PERMIT R . e